Atypical neuroleptic malignant syndrome without hyperthermia or rigidity in the ıntensive care unit: a diagnostic challenge
Acta Neurologica Belgica, cilt.126, sa.4, ss.1423-1426, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Kısa Makale
- Cilt numarası: 126 Sayı: 4
- Basım Tarihi: 2026
- Doi Numarası: 10.1007/s13760-026-03068-y
- Dergi Adı: Acta Neurologica Belgica
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, EMBASE, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO), Health Research Premium Collection (ProQuest)
- Sayfa Sayıları: ss.1423-1426
- Anahtar Kelimeler: Neuroleptic malignant syndrome, Atypical presentation, Dopamine antagonists, Paratonia, Intensive care unit
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Neuroleptic malignant syndrome (NMS) is a potentially life-threatening condition associated with dopamine antagonist medications. Although the classical presentation includes hyperthermia, generalized rigidity, autonomic instability, and altered mental status, atypical forms lacking these features may occur and complicate diagnosis. We report a case most consistent with atypical NMS in a 76-year-old patient who developed acute delirium and intermittent paratonia without fever or sustained rigidity following antipsychotic exposure. The clinical course was characterized by marked autonomic instability and a transient elevation of creatine kinase, peaking early and subsequently normalizing. A temporal relationship between antipsychotic exposure, symptom onset, and laboratory findings supported the diagnostic consideration. Although clinical improvement was observed following dopaminergic therapy, this finding was interpreted cautiously given potential confounding factors. This case highlights that NMS may occur without fulfilling classical diagnostic criteria and underscores the importance of integrating clinical, laboratory, and temporal features, particularly in critically ill patients.