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Neuroleptic Malignant Syndrome, Emergency Medicine

Daniel L. Beskind Reviewed 06/2017



  • Life-threatening neurologic disorder most often caused by an adverse reaction to a neuroleptic or antipsychotic medication.

  • Mortality can be as high as 20%

  • May develop any time during ...


Signs and Symptoms

  • Life-threatening condition

  • Hallmarks of the disease:

    • Hyperthermia (temperature may be as high as 106–107°F, 41°C)

    • Altered level of consciousness—stupor

    • Significant skeletal mus...



  • Ventilation may be difficult because of chest wall rigidity

  • Cool the patient and treat seizures if they occur

  • Check fingerstick glucose

Initial Stabilization/Therapy

  • Airway intervent...



Admission Criteria

  • Patients with NMS should be admitted

  • Patients will often require intensive care

Followup Recommendations

Patients and families must be counseled on the future use o...

Pearls and Pitfalls

  • Maintain high clinical suspicion for NMS in patients on neuroleptics with mental status changes, rigidity, fever, or dysautonomia

  • Must rule out other causes of fever and altered men...

Additional Reading

  • Bellamy  CJ, Kane-Gill  SL, Falcione  BA, et al. Neuroleptic malignant syndrome in traumatic brain injury patients treated with haloperidol. J Trauma.  2009;66:954–958.

  • Marx  JA...



333.92 Neuroleptic malignant syndrome 


G21.0 Malignant neuroleptic syndrome 


  • 15244003 Neuroleptic malignant syndrome (disorder)

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