Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report
Autor(a) principal: | |
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Data de Publicação: | 2021 |
Outros Autores: | , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019 |
Resumo: | Neuroleptic malignant syndrome is a neurological emergency caused by dysregulation of dopaminergic neurotransmission. While it is typically characterized by muscle rigidity, fever and altered mental status, it may have a heterogeneous and non-specific presentation, leading to delays in diagnosis and treatment. Treatment involves cessation of dopamine-receptor antagonists and supportive measures, but in more severe cases, bromocriptine, dantrolene, benzodiazepines and/or electroconvulsive therapy should be considered. We present the case of a 66-year-old man with severe neuroleptic malignant syndrome, diagnosed due to need for continuous invasive ventilation in an Intensive Care Unit, after successful treatment for respiratory sepsis. The patient recovered after electroconvulsive therapy and administration of bromocriptine. This unusually severe case illustrates the need for a high level of suspicion for neuroleptic malignant syndrome in critically ill patients with malignant catatonic syndromes, allowing for an early diagnosis and potentially lifesavingtreatment. |
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Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case ReportDiagnóstico e Tratamento de Síndrome Maligno dos Neurolépticos em Unidade de Cuidados Intensivos: Relato de um Caso ClínicoIntensive Care UnitsNeuroleptic Malignant Syndrome/diagnosisNeuroleptic Malignant Syndrome/therapySíndrome Maligna dos Neurolépticos/diagnósticoSíndrome Maligna dos Neurolépticos/tratamentoUnidades de Cuidados IntensivosNeuroleptic malignant syndrome is a neurological emergency caused by dysregulation of dopaminergic neurotransmission. While it is typically characterized by muscle rigidity, fever and altered mental status, it may have a heterogeneous and non-specific presentation, leading to delays in diagnosis and treatment. Treatment involves cessation of dopamine-receptor antagonists and supportive measures, but in more severe cases, bromocriptine, dantrolene, benzodiazepines and/or electroconvulsive therapy should be considered. We present the case of a 66-year-old man with severe neuroleptic malignant syndrome, diagnosed due to need for continuous invasive ventilation in an Intensive Care Unit, after successful treatment for respiratory sepsis. The patient recovered after electroconvulsive therapy and administration of bromocriptine. This unusually severe case illustrates the need for a high level of suspicion for neuroleptic malignant syndrome in critically ill patients with malignant catatonic syndromes, allowing for an early diagnosis and potentially lifesavingtreatment.A síndrome maligna dos neurolépticos é uma emergência neurológica causada pela desregulação da neurotransmissão dopaminérgica. Apesar de habitualmente caracterizada por rigidez muscular, febre e alteração do estado mental, pode apresentar-se de forma inespecífica e heterogénea, atrasando o diagnóstico e tratamento. O tratamento engloba a interrupção de antagonistas dos receptores dopaminérgicos, medidas de suporte e, em casos mais graves, bromocriptina, dantroleno, benzodiazepinas e/ou terapia electroconvulsiva. Neste artigo descrevemos o caso clínico de um homem de 66 anos com síndrome maligna dos neurolépticos grave, diagnosticada devido à necessidade de ventilação artificial continuada na Unidade de Cuidados Intensivos, após tratamento de uma sépsis respiratória. O doente melhorou significativamente após terapia electroconvulsiva e administração de bromocriptina. Este caso, de gravidade particular, sublinha a necessidade de manter um elevado nível de suspeita de síndrome maligna dos neurolépticos em doentes em estado crítico com síndromes catatónicos malignos, permitindo assim um diagnóstico precoce e tratamento dirigido.Ordem dos Médicos2021-06-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articleapplication/pdfvideo/mp4video/mp4video/mp4image/jpegimage/jpegimage/jpegapplication/pdfapplication/pdfapplication/pdfapplication/pdfimage/pngimage/pngimage/pngimage/pngimage/pngimage/pngapplication/vnd.openxmlformats-officedocument.wordprocessingml.documentimage/jpegapplication/pdfhttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019oai:ojs.www.actamedicaportuguesa.com:article/13019Acta Médica Portuguesa; Vol. 34 No. 6 (2021): June; 464-467Acta Médica Portuguesa; Vol. 34 N.º 6 (2021): Junho; 464-4671646-07580870-399Xreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttps://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/6154https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/6127https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/6128https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/6129https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/11962https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/11963https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/11964https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12017https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12018https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12019https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12020https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12021https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12022https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12023https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12024https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12025https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12026https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12142https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12143https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019/12482Direitos de Autor (c) 2020 Acta Médica Portuguesainfo:eu-repo/semantics/openAccessMaia, AnaCotovio, GonçaloBarahona-Corrêa, BernardoOliveira-Maia, Albino J.2022-12-20T11:06:45Zoai:ojs.www.actamedicaportuguesa.com:article/13019Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:20:15.952524Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report Diagnóstico e Tratamento de Síndrome Maligno dos Neurolépticos em Unidade de Cuidados Intensivos: Relato de um Caso Clínico |
title |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report |
spellingShingle |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report Maia, Ana Intensive Care Units Neuroleptic Malignant Syndrome/diagnosis Neuroleptic Malignant Syndrome/therapy Síndrome Maligna dos Neurolépticos/diagnóstico Síndrome Maligna dos Neurolépticos/tratamento Unidades de Cuidados Intensivos |
title_short |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report |
title_full |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report |
title_fullStr |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report |
title_full_unstemmed |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report |
title_sort |
Diagnosis and Treatment of Neuroleptic Malignant Syndrome in the Intensive Care Unit: A Case Report |
author |
Maia, Ana |
author_facet |
Maia, Ana Cotovio, Gonçalo Barahona-Corrêa, Bernardo Oliveira-Maia, Albino J. |
author_role |
author |
author2 |
Cotovio, Gonçalo Barahona-Corrêa, Bernardo Oliveira-Maia, Albino J. |
author2_role |
author author author |
dc.contributor.author.fl_str_mv |
Maia, Ana Cotovio, Gonçalo Barahona-Corrêa, Bernardo Oliveira-Maia, Albino J. |
dc.subject.por.fl_str_mv |
Intensive Care Units Neuroleptic Malignant Syndrome/diagnosis Neuroleptic Malignant Syndrome/therapy Síndrome Maligna dos Neurolépticos/diagnóstico Síndrome Maligna dos Neurolépticos/tratamento Unidades de Cuidados Intensivos |
topic |
Intensive Care Units Neuroleptic Malignant Syndrome/diagnosis Neuroleptic Malignant Syndrome/therapy Síndrome Maligna dos Neurolépticos/diagnóstico Síndrome Maligna dos Neurolépticos/tratamento Unidades de Cuidados Intensivos |
description |
Neuroleptic malignant syndrome is a neurological emergency caused by dysregulation of dopaminergic neurotransmission. While it is typically characterized by muscle rigidity, fever and altered mental status, it may have a heterogeneous and non-specific presentation, leading to delays in diagnosis and treatment. Treatment involves cessation of dopamine-receptor antagonists and supportive measures, but in more severe cases, bromocriptine, dantrolene, benzodiazepines and/or electroconvulsive therapy should be considered. We present the case of a 66-year-old man with severe neuroleptic malignant syndrome, diagnosed due to need for continuous invasive ventilation in an Intensive Care Unit, after successful treatment for respiratory sepsis. The patient recovered after electroconvulsive therapy and administration of bromocriptine. This unusually severe case illustrates the need for a high level of suspicion for neuroleptic malignant syndrome in critically ill patients with malignant catatonic syndromes, allowing for an early diagnosis and potentially lifesavingtreatment. |
publishDate |
2021 |
dc.date.none.fl_str_mv |
2021-06-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019 oai:ojs.www.actamedicaportuguesa.com:article/13019 |
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https://www.actamedicaportuguesa.com/revista/index.php/amp/article/view/13019 |
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oai:ojs.www.actamedicaportuguesa.com:article/13019 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
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Direitos de Autor (c) 2020 Acta Médica Portuguesa info:eu-repo/semantics/openAccess |
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Direitos de Autor (c) 2020 Acta Médica Portuguesa |
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Ordem dos Médicos |
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Ordem dos Médicos |
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Acta Médica Portuguesa; Vol. 34 No. 6 (2021): June; 464-467 Acta Médica Portuguesa; Vol. 34 N.º 6 (2021): Junho; 464-467 1646-0758 0870-399X reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
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