title: Neuroleptic Malignant Syndrome Associated with Refractory Acute Disseminated Encephalomyelitis.
abstract: We present the case of a young man who was transferred to our hospital with worsening acute disseminated encephalomyelitis (ADEM) despite treatment with intravenous methylprednisolone, intravenous immunoglobulin and plasma exchange. He developed neuroleptic malignant syndrome (NMS) without the use of dopamine-modulating drugs. His progressive clinical improvement started after treatment with intravenous cyclophosphamide and methylprednisolone. In our patient, acute demyelination with severe bilateral inflammation of the basal ganglia could have caused a state of central dopamine depletion, creating proper conditions for the development of NMS. Significant clinical improvement of our case after treatment with intravenous cyclophosphamide and steroids provides further evidence for a possible role of the inflammatory lesions in the pathogenesis of NMS in association with ADEM.
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Silvia R
authors.initials: SR
authors.lastname: Delgado
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Leticia
authors.initials: L
authors.lastname: Tornes
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Janice
authors.initials: J
authors.lastname: Maldonado
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Hernandez
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Yesica
authors.initials: Y
authors.lastname: Campos
authors.affiliation: Department of Neurology, University of Miami Miller School of Medicine, Miami, Fla., USA.
authors.forename: Kottil
authors.initials: K
authors.lastname: Rammohan
keywords: Acute disseminated encephalomyelitis; Central nervous system demyelinating disease; Neuroleptic malignant syndrome