Fatal neurotoxic response to neuroleptic medications: case report and review of the literature.
Neuroleptic malignant syndrome (NMS) is a diagnosis of exclusion difficult to make due to a lack of pathognomonic features. Diagnosing NMS by postmortem examination becomes increasingly challenging when possible underlying brain pathology is obscured. The diagnosis is based on clinical history and laboratory findings. Autopsy and histologic findings, if any, usually are reflective of hyperthermia or complications (eg, aspiration pneumonia) of NMS. The authors describe a case of a 36-year-old Hispanic woman with a presumptive diagnosis of pseudoseizures, treated with various combinations of neuroleptic medications over a 6-week period prior to her sudden, unexpected, in-hospital death. Neuroleptic malignant syndrome is likely to have contributed to this patient's death. Confounding factors and medicolegal issues of a postmortem diagnosis of NMS are discussed.
Sheil
Amy T
AT
Medical University of South Carolina, Charleston, South Carolina, USA.
Collins
Kim A
KA
Schandl
Cynthia A
CA
Harley
Russell A
RA
D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000927:Anticonvulsants / Q000009:adverse effects; D001921:Brain / Q000473:pathology; D003402:Creatine Kinase / Q000097:blood; D003681:Dehydration / Q000209:etiology; D005260:Female; D005334:Fever / Q000209:etiology; D005554:Forensic Medicine; D006801:Humans; D020896:Hypovolemia / Q000209:etiology; D017114:Liver Failure, Acute / Q000209:etiology; D009127:Muscle Rigidity / Q000209:etiology; D009459:Neuroleptic Malignant Syndrome / Q000175:diagnosis*; D011619:Psychotropic Drugs / Q000009:adverse effects; D014202:Tremor / Q000209:etiology
D000927:Anticonvulsants; D011619:Psychotropic Drugs; D003402:Creatine Kinase