1
|
Aziz AA, Aziz MA, Shah R. A Rare Case of Malignant Syndrome in Parkinson's Disease Caused by Severe Dehydration and Complicated by Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Cureus 2023; 15:e42377. [PMID: 37621801 PMCID: PMC10445550 DOI: 10.7759/cureus.42377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2023] [Indexed: 08/26/2023] Open
Abstract
Malignant syndrome (MS) in Parkinson's disease (PD) is a rare complication that occurs in patients who have a history of PD and are taking dopaminergic drugs. The syndrome is quite similar to neuroleptic malignant syndrome (NMS) in presentation and is a potentially fatal syndrome. Awareness of symptoms, early diagnosis, and the ability to differentiate it from NMS is important to prevent mortality. Clinical manifestations of MS are similar to NMS and include altered mentation, rigidity, fever, leukocytosis, and elevated serum creatine kinase (CK). However, MS is differentiated from NMS by the precipitating factors; of which, the commonest precipitating factor for MS is dopaminergic drug withdrawal or dose reduction while other less common causes include infection, dehydration, and hot weather. We present a rare case of MS in a patient with a history of PD precipitated by severe dehydration and hot weather in the absence of dopaminergic drug withdrawal. He presented with fever, severe rigidity, altered mentation, dehydration, leukocytosis, and elevated CK. He was correctly diagnosed with MS and promptly treated, preventing mortality. The triad of fever, severe rigidity, and altered sensorium in a patient with a history of PD should prompt evaluation for MS in addition to NMS to initiate appropriate treatment and prevent mortality.
Collapse
Affiliation(s)
- Ahmed Ali Aziz
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | | | - Rehan Shah
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| |
Collapse
|
2
|
Lin Y, Ma L, Zhang N, Li R, Jiang W. Neuroleptic malignant-like syndrome associated multiple system atrophy: report on three cases. BMC Neurol 2022; 22:67. [PMID: 35216572 PMCID: PMC8876065 DOI: 10.1186/s12883-022-02583-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/09/2022] [Indexed: 11/24/2022] Open
Abstract
Background Multiple system atrophy (MSA) associated with neuroleptic malignant-like syndrome (NMLS) is rare and few cases have been described in the literature. Case presentation In the present study, three patients with MSA associated with NMLS were analyzed from January 2012 to January 2020 to characterize their clinical presentations. Data collected from the patients for analysis included general patient history, the fluctuation and severity of disease symptoms, the indicated therapies and disease progression at follow-up. All patients had histories of sudden withdrawal or reduction of levodopa prior to the onset of symptoms. Clinical presentations were characterized by hyperthermia, autonomic dysfunction, worsening of extrapyramidal symptoms, and elevated serum creatine kinase (CK) levels. During hospitalization, one patient rapidly progressed and died, while the other two patients were successfully treated. Conclusions Early diagnosis and treatment are very important for patient outcomes in NMLS. Notably, the correct dose and time of administration of dopaminergic medication may be key in treating NMLS. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-022-02583-8.
Collapse
Affiliation(s)
- Yan Lin
- Department of Geriatric Medicine and Shandong Key Laboratory of Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Lin Ma
- Department of Geriatric Medicine and Shandong Key Laboratory of Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Nan Zhang
- Department of Geriatric Medicine and Shandong Key Laboratory of Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Ruihua Li
- Department of Geriatric Medicine and Shandong Key Laboratory of Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 West Wenhua Road, Jinan, 250012, Shandong, China
| | - Wenjing Jiang
- Department of Geriatric Medicine and Shandong Key Laboratory of Cardiovascular Proteomics, Qilu Hospital, Cheeloo College of Medicine, Shandong University, No. 107 West Wenhua Road, Jinan, 250012, Shandong, China. .,Shandong Key Laboratory of Cardiovascular Proteomics, Qilu Hospital, Shandong University, Jinan, 250012, Shandong, China.
| |
Collapse
|
3
|
Lee DH, Moon JM, Cho YS. Malignant Syndrome in Parkinson Disease Similar to Severe Infection. Korean J Crit Care Med 2017; 32:359-362. [PMID: 31723658 PMCID: PMC6786682 DOI: 10.4266/kjccm.2016.00087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 06/02/2016] [Accepted: 08/12/2016] [Indexed: 01/09/2023] Open
Abstract
A 70-year-old woman with Parkinson disease was admitted to the emergency department with altered consciousness, fever and convulsive movements without experiencing withdrawal from antiparkinsonian medication. Six hours after the emergency department visit, the patient had a hyperpyrexia (> 40°C) and a systolic blood pressure of 40 mmHg. There was no evidence of bacterial infection based on extensive workups. The patient was discharged without aggravation of Parkinson disease symptoms after treatment that included administration of dantrolene sodium, enforcement of continuous renal replacement therapy and cooling blankets. Malignant syndrome should be suspected if high fever occurs in Parkinson disease patients without evidence of a definitive infection.
Collapse
Affiliation(s)
- Dong Hun Lee
- Department of Emergency Medicine, Chonnam University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jeong Mi Moon
- Department of Emergency Medicine, Chonnam University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Soo Cho
- Department of Emergency Medicine, Chonnam University Hospital, Chonnam National University Medical School, Gwangju, Korea
| |
Collapse
|
4
|
Malek N, Baker MR. Common toxidromes in movement disorder neurology. Postgrad Med J 2017; 93:326-332. [PMID: 28546460 DOI: 10.1136/postgradmedj-2016-134254] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND Physicians can come across patients who are exposed to certain prescription drugs or toxins that can result in adverse effects and complications which have high rates of morbidity and mortality. OBJECTIVE To summarise the key clinical features and management of the common movement disorder toxidromes relevant to physicians (with an interest in neurology). METHODS We searched PUBMED from 1946 to 2016 for papers relating to movement toxidromes and their treatment. The findings from those studies were then summarised and are presented here. RESULTS The key features of 6 of the common movement disorder toxidromes and their treatment are tabulated and highlighted. The management of toxidromes with the highest mortality like neuroleptic malignant syndrome and serotonin syndrome are discussed in detail. CONCLUSION There are several toxidromes that have the potential to become a serious life-threatening emergency if there is a delay in recognition of key clinical features and instituting the appropriate treatment at the earliest is crucial.
Collapse
Affiliation(s)
- N Malek
- Department of Neurology, Ipswich Hospital NHS Trust, Ipswich, UK
| | - M R Baker
- Department of Neurology, Royal Victoria Infirmary, Newcastle-upon-Tyne, UK
- Department of Clinical Neurophysiology, Royal Victoria Infirmary, Newcastle -upon-Tyne, UK
- Institute of Neuroscience, The Medical School, Newcastle University, Newcastle-upon-Tyne, UK
| |
Collapse
|
5
|
Abstract
Objective: To review evidence for the treatment of neuroleptic malignant syndrome (NMS) and to discuss how to rechallenge patients with neuroleptics when continued pharmacotherapy for chronic psychological illness is required. Data Sources: A PubMed search was conducted through March 2016 using available medical subject heading (MeSH) terms and keywords that included neuroleptic malignant syndrome, treatment, dantrolene, and bromocriptine. A manual search of article reference sections followed. Study Selection and Data Extraction: Case reports and case series in English that discussed NMS and atypical NMS treatment as well as neuroleptic rechallenge were included for review. Data Synthesis: The reported incidence of NMS was 0.02% to 0.03%, with a mortality rate of 5.6%. Current literature on NMS is primarily retrospective and emphasizes diagnostic criteria, causative agents, and potential pharmacotherapy. Details regarding timing of administration, dose, and duration of pharmacotherapy are inconsistently reported. Reported dosing strategies and outcomes have been summarized. Instances of rechallenge were infrequently reported but demonstrate that recurrence may happen at any time after NMS resolution. Recommendations regarding safe rechallenge are provided. Conclusion: NMS is a rare adverse drug reaction, with a complex pathophysiology and presentation. Timely diagnosis and discontinuation of antipsychotic therapy is the first-line treatment, followed by supportive care and pharmacotherapy. Antipsychotic rechallenge is often required and should be attempted only after a drug-free period and with a different agent, slowly titrated with close monitoring.
Collapse
Affiliation(s)
| | - Aaron M. Cook
- University of Kentucky Chandler Medical Center, Lexington, KY, USA
- University of Kentucky College of Pharmacy, Department of Pharmacy Practice and Science, Lexington, KY, USA
| |
Collapse
|
6
|
Chandran CJS. Malignant syndrome in Parkinson's disease without dopaminergic drug withdrawal. Ann Indian Acad Neurol 2010; 11:248-50. [PMID: 19893683 PMCID: PMC2771991 DOI: 10.4103/0972-2327.44562] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2008] [Revised: 05/01/2008] [Accepted: 06/12/2008] [Indexed: 12/05/2022] Open
Abstract
Malignant syndrome is a rare complication occurring during the course of drug treatment for Parkinson's disease. It resembles neuroleptic malignant syndrome and is characterized by fever, marked rigidity, altered consciousness, leucocytosis and elevated creatine kinase. Malignant syndrome is a potentially fatal condition and awareness of this condition is imperative for prevention and treatment. The commonest precipitating factor is dopaminergic drug withdrawal or dose reduction. We report malignant syndrome (precipitated by hyponatremia) in a case of Parkinson's disease, in the absence of dopaminergic drug withdrawal. A 60-year-old man presented with fever, severe rigidity and altered sensorium following repeated vomiting. On investigation, he was found to have hyponatremia precipitated malignant syndrome. Treatment with hydration, cooling, correction of hyponatremia and dopaminergic drugs reversed his condition. The triad of fever, severe rigidity and altered sensorium should prompt evaluation for malignant syndrome in Parkinson's disease.
Collapse
Affiliation(s)
- C J Suresh Chandran
- Department of Neurology, Kerala Institute of Medical Sciences, Trivandrum, Kerala, India.
| |
Collapse
|
7
|
Reulbach U, Dütsch C, Biermann T, Sperling W, Thuerauf N, Kornhuber J, Bleich S. Managing an effective treatment for neuroleptic malignant syndrome. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2007; 11:R4. [PMID: 17222339 PMCID: PMC2151884 DOI: 10.1186/cc5148] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2006] [Revised: 12/20/2006] [Accepted: 01/12/2007] [Indexed: 11/10/2022]
Abstract
INTRODUCTION Neuroleptic malignant syndrome (NMS) is a rare, but sometimes fatal, adverse reaction to neuroleptics characterized principally by fever and rigor. The aim of this study was to prove the efficacy of different NMS treatment strategies, focusing on the efficacy of dantrolene. METHODS Altogether, 271 case reports were included. These cases were categorized into four treatment groups and compared to each other according to effectiveness of therapy within 24 hours, mortality, complete time of remission in days, effectiveness due to increase of dosage, relapse on the basis of decrease of dosage, and improvement of symptoms. RESULTS Between the four treatment groups, the complete time of remission was significantly different (analysis of variance, F = 4.02; degrees of freedom = 3; p = 0.008). In a logistic regression with adjustment for age, gender, and severity code, no significant predictor of the treatment for the complete time of remission (dichotomized by median) could be found. However, if the premedication was a monotherapy with neuroleptics, the complete time of remission was significantly shorter with dantrolene monotherapy (t = -2.97; p = 0.004). CONCLUSION The treatment of NMS with drugs that are combined with dantrolene is associated with a prolongation of clinical recovery. Furthermore, treatment of NMS with dantrolene as monotherapy seems to be associated with a higher overall mortality. Therefore, dantrolene does not seem to be the evidence-based treatment of choice in cases of NMS but might be useful if premedication consisted of a neuroleptic monotherapy.
Collapse
Affiliation(s)
- Udo Reulbach
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| | - Carmen Dütsch
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| | - Teresa Biermann
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| | - Wolfgang Sperling
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| | - Norbert Thuerauf
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| | - Johannes Kornhuber
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| | - Stefan Bleich
- Department of Psychiatry and Psychotherapy, Friedrich Alexander University of Erlangen-Nuremberg, Schwabachanlage 6, D-91054 Erlangen, Germany
| |
Collapse
|
8
|
Gaig C, Martí MJ, Tolosa E, Gómez-Choco MJ, Amaro S. Parkinsonism–hyperpyrexia syndrome not related to antiparkinsonian treatment withdrawal during the 2003 summer heat wave. J Neurol 2005; 252:1116-9. [PMID: 15778809 DOI: 10.1007/s00415-005-0798-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Revised: 12/13/2004] [Accepted: 01/03/2005] [Indexed: 11/26/2022]
|
9
|
Sechi G, Agnetti V, Masuri R, Deiana GA, Pugliatti M, Paulus KS, Rosati G. Risperidone, neuroleptic malignant syndrome and probable dementia with Lewy bodies. Prog Neuropsychopharmacol Biol Psychiatry 2000; 24:1043-51. [PMID: 11041543 DOI: 10.1016/s0278-5846(00)00123-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
1. Conflicting reports are available regarding the sensitivity of patients with Dementia with Lewy bodies (DLB) to risperidone. 2. The authors studied a rare familial case of probable DLB, who developed a documented episode of neuroleptic malignant syndrome (NMS) following the exposure to risperidone. Previously, the patient had had an episode of NMS on trifluoperazine. 3. The discontinuance of risperidone, in combination with a mild increase of dopaminergic therapy, led to a complete recovery in few days. 4. In patients with DLB, a continued vigilance for extrapyramidal side effects, including NMS, would be advisable during the use of risperidone.
Collapse
Affiliation(s)
- G Sechi
- Department of Neurology, University of Sassari, Italy.
| | | | | | | | | | | | | |
Collapse
|
10
|
Abstract
Neuroleptic malignant syndrome is a clinical syndrome characterized by fever, muscle rigidity, and mutism. Some patients with neuroleptic syndrome may have elevated creatine phosphokinase values and abnormal liver aminotransferase values. Precipitating factors are important clues for prompt diagnosis. Typical precipitating factors include antipsychotic agents and major tranquilizers. In Parkinson disease, drug withdrawal, menstruation, and hyponatremia are precipitating factors. We report a case of neuroleptic malignant syndrome in a patient with Parkinson disease and hypernatremia. In addition, we hypothesized that sudden change of sodium concentrations in the central nervous system could trigger neuroleptic malignant syndrome in patients with Parkinson disease. According to our experience, neuroleptic malignant syndrome is a clinical diagnosis and prompt diagnosis avoids unnecessary, expensive work-ups.
Collapse
Affiliation(s)
- L Cao
- Department of Medicine, Mercy Hospital of Philadelphia, Mercy Catholic Medical Center, Pennsylvania 19143, USA
| | | |
Collapse
|
11
|
Demet EM, Chicz-Demet A, Fallon JH, Sokolski KN. Sleep deprivation therapy in depressive illness and Parkinson's disease. Prog Neuropsychopharmacol Biol Psychiatry 1999; 23:753-84. [PMID: 10509373 DOI: 10.1016/s0278-5846(99)00039-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
1. Sleep deprivation is commonly associated with feelings of fatigue and cognitive impairment. 2. Patients with depressive illness, however, often experience mood improvements under these same conditions. 3. Other studies now show that tremor and rigidity, in patients with Parkinson's disease, are also improved by sleep depression therapy. 4. The neural substrates which underlie these effects are unclear. Some recent evidence, however, suggests that sleep deprivation may activate mechanisms which are otherwise typical of conditions of metabolic stress. 5. A common feature of these mechanisms is the suppression of cholinergic activity which is thought to be excessive, in relation to monoamine transmission, in both depression and Parkinson's disease.
Collapse
Affiliation(s)
- E M Demet
- Mental Health Care Group, VA Medical Center, Long Beach, CA, USA
| | | | | | | |
Collapse
|
12
|
|