Q. A 29 yr old male is brought to the Emergency Department in a state of confusion. His temperature is 104 degree F, pulse 98 per minute and Blood Pressure 186/100 mm Hg. He is sweating and holds a rigid posture. His serum Creatine Phosphokinase is 150U/L, serum Urea 86mg/dl and serum Creatinine 6mg/dl. He was diagnosed as a case of schizophrenia one month ago and he has been taking medication regularly since then. The most likely diagnosis at his moment for the patient is – 

a. Neuroleptic Malignant Syndrome

b. Tardive Dyskinesia

c. Hypertensive Nephropathy

d. Cerebral Malaria

e. Encephalitis 

Explanation

The answer is  (a). This patient is suffering from Neuroleptic Malignant Syndrome . Neuroleptic is term used alternately for antipsychotic drugs. It occurs early in treatment with anti psychotics (Haloperidol ) in therapeutic doses, as a reaction. It is characterized by high fever, confusion, muscular rigidity, renal failure, high blood pressure, and high Creatine Phosphokinase levels. It is a medical emergency with mortality rate reaching up to 20%. Drugs causing Neuroleptic Malignant Syndrome are Butyrophenones, including haloperidol and bromperidol, fluoxetin, loxapine, metoclopramide, domperidone, thiothixene, molindone. Do not confuse it with Malignant Hyperthermia which is caused by inhalation anesthetics (halothane) and suucinylcholine.

Tardive Dyskinesia (tardy-late, ie occurs after long term treatment, dys- difficulty, kinesia-movement) is choreoathetoid movements of face and limbs due to long term treatment with antipsyschotic medication.

(c,d,e) are not correct. Though patient has fever, high Blood Pressure and raised renal parameters, the given clinical setting is more suggestive of option (a).