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Neuroleptic Malignant Syndrome — SCE Neurology MCQ

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EasyMovement DisordersNeuroleptic Malignant SyndromeSCE Neurology

A 35-year-old man on olanzapine for schizophrenia presents with acute onset of severe rigidity, hyperthermia (40.5°C), altered consciousness, tachycardia, diaphoresis, and labile blood pressure. CK is 15,000 IU/L. White cell count is 14 × 10⁹/L. What is the diagnosis and the most important treatment steps?

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Correct answer: C — Neuroleptic malignant syndrome — stop the causative agent, supportive care, consider dantrolene and bromocriptine

NMS is caused by dopamine D2 receptor blockade (antipsychotics, metoclopramide, antiemetics). Features include severe rigidity ('lead pipe'), hyperthermia, altered consciousness, autonomic instability, and markedly elevated CK (rhabdomyolysis). Treatment: (1) stop the causative agent immediately, (2) aggressive supportive care (IV fluids, cooling, monitoring), (3) consider dantrolene (for rigidity/hyperthermia) and/or bromocriptine/amantadine (dopamine agonists). Mortality is ~10% if untreated. A: Serotonin syndrome has clonus and hyperreflexia (not rigidity) and is caused by serotonergic agents. C: Malignant hyperthermia occurs under general anaesthesia. D: Lethal catatonia overlaps but requires different approach. E: Thyroid storm has different precipitants.

Reference: BNF; NICE CG178 Psychosis; Boyer & Shannon Serotonin Syndrome Review