Neuroleptic Malignant Syndrome: An Intensive Care Unit Case of Exceptionally High Creatinine Kinase and Myoglobin Levels

Abstract

Neuroleptic Malignant Syndrome (NMS) is a rare, life-threatening neurologic emergency known to be related to the administration or sudden withdrawal of dopaminergic medications. The clinical course, symptoms, and bloodwork are very heterogeneous, making this syndrome difficult to identify. Thus, NMS is a diagnosis of exclusion. We present a case of severe NMS with exceptionally high creatinine kinase (CK) and myoglobin levels with unclear etiology and a challenging differential diagnosis. Also, our case stands out because it was serious, unique, and had a favorable outcome, which could contribute to the management of future similar cases.

Keywords: acute renal failure; antipsychotic medications; dopamine; neuroleptic malignant syndrome; neurologic emergency; rhabdomyolysis.

Figure 1. Axial section of cranial computed tomography scan

Ventricular enlargement is characteristic of patients with Schizophrenia. It should be noted that there is no evidence of infection.

Figure 2. Electroencephalogram

Encephalopathy likely related to sedative therapy. Exam without registration epileptiform activity.