Why the study?
Reports of atypical neuroleptic malignant syndrome associated with lower-potency antipsychotic medications have been conflicting, and COVID-19 adds diagnostic complexity to critical care patient management.
Atypical neuroleptic malignant syndrome can present without classic muscle rigidity in critically ill COVID-19 patients receiving second-generation antipsychotics, and may respond to prompt dantrolene administration.
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May support dantrolene for atypical NMS without rigidity in COVID-19; hypothesis-generating and should not yet change practice.
Neuroleptic malignant syndrome (NMS) has been defined as a life-threatening neurologic emergency related to the use of antipsychotic medications. It is most often seen with high-potency (first-generation) antipsychotic medications and may occur after a single dose. There have been conflicting reports in the literature of an atypical NMS (ANMS) presentation, associated with lower-potency agents (second generation) antipsychotic medications. NMS is usually diagnosed with a tetrad of clinical symptoms although none of the tetrads is needed for diagnosis. We report a case of a patient admitted for severe acute syndrome coronavirus 2 (SARS-CoV2) pneumonia who developed probable ANMS. SARS-CoV2 also referred to as coronavirus disease 2019 (COVID-19) added another dimension of complication to patient care as we have, at this time, an incomplete understanding of the pathogenesis. We feel critical care clinicians should maintain broad differentials to clinical findings, during the use of multiple medications and not simply attribute the various presentations to COVID-19.
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Durbach et al. (2022) studied this question.
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