1/23. Recognition and management of acute neuroleptic-induced extrapyramidal motor and mental syndromes.After nearly 50 years of therapeutic application of neuroleptics, diagnosis and classification of neuroleptic-induced extrapyramidal syndromes still concentrate on their "neurological" (motor) aspects. Psychiatric (mental) aspects are in general - if at all - regarded as "secondary" to motor symptoms. Psychiatric side effects of neuroleptics (including psychotic exacerbations during neuroleptic treatment) have, however, anecdotally been reported since 1954 but never developed into a systematic classification. Accordingly, psychiatric manifestations of extrapyramidal side effects frequently are overlooked, misdiagnosed as psychotic deteriorations and treated by increased dosing of neuroleptics instead anticholinergics, which in addition are falsely suspected of bearing a high addictive potential and the risk of development of tardive dyskinesia. It is suggested that neuroleptic-induced basal ganglia dysfunction results in motor as well as mental extrapyramidal side effects, whose recognition and management is essential to achieve better tolerability of and thereby compliance with neuroleptic treatment.- - - - - - - - - - ranking = 1keywords = extrapyramidal (Clic here for more details about this article) |
2/23. Hypotensive akathisia: autonomic failure associated with leg fidgeting while sitting.The author describes a distinct clinical syndrome in six patients with autonomic failure who manifested habitual, voluntary, transiently suppressible, yet irresistible leg movements occurring only in the sitting position. Keeping the legs still brought on vague symptoms of fatigue, lightheadedness, or apprehension. Repetitive leg crossing, muscle tensing, foot twirling or wiggling, or heel or toe floor tapping while sitting may have compensated for orthostatic hypotension and raised systolic blood pressure by a mean of 28 mm Hg and diastolic pressure by a mean of 11 mm Hg.- - - - - - - - - - ranking = 3.7373514332161E-5keywords = muscle (Clic here for more details about this article) |
3/23. neuroleptic malignant syndrome in pregnancy.BACKGROUND: neuroleptic malignant syndrome can be a serious neurologic complication of drug therapy during pregnancy. CASE: A young woman was admitted to the intensive care unit with worsening varicella pneumonia. After being given haldol for agitation, she developed fever, increasing agitation, rigidity, tachycardia, and tremors; she was diagnosed as having neuroleptic malignant syndrome. She was treated successfully with bromocriptine and dantrolene. CONCLUSION: Despite the common use of antipsychotic medications, neuroleptic malignant syndrome is seen infrequently during pregnancy. The diagnosis can be difficult to make, but if suspected, it can be treated successfully.- - - - - - - - - - ranking = 0.29800959033509keywords = rigidity (Clic here for more details about this article) |
4/23. Failed challenge with quetiapine after neuroleptic malignant syndrome with conventional antipsychotics.neuroleptic malignant syndrome (NMS) is an uncommon but potentially life-threatening adverse effect associated with conventional antipsychotic agents. The syndrome is characterized by muscular rigidity, hyperpyrexia, altered consciousness, and autonomic dysfunction. Few cases of quetiapine-induced NMS have been reported. A 54-year-old man was unsuccessfully challenged with quetiapine after conventional antipsychotic-induced NMS.- - - - - - - - - - ranking = 0.29800959033509keywords = rigidity (Clic here for more details about this article) |
5/23. Rabbitfish ("aras"): an unusual source of ciguatera poisoning.BACKGROUND: ciguatera poisoning is the commonest fish-borne seafood intoxication. It is endemic to warm water tropical areas and is caused by consumption of bottom-dwelling shore reef fish, mostly during spring and summer. The causative agent, ciguatoxin, is a heat-stable ester complex that becomes concentrated in fish feeding on toxic dinoflagellates. The common clinical manifestations are a combination of gastrointestinal and neurologic symptoms. Severe poisoning may be associated with seizures and respiratory paralysis. OBJECTIVE: To describe a series of patients who sustained ciguatera poisoning in an uncommon region and from an unexpected source. patients: Two families complained of a sensation of "electrical currents," tremors, muscle cramps, nightmares, hallucinations, agitation, anxiety and nausea of varying severity several hours after consuming rabbitfish ("aras"). These symptoms lasted between 12 and 30 hours and resolved completely. The temporal relationship to a summer fish meal, the typical clinical manifestations along with the known feeding pattern of the rabbitfish suggested ciguatera poisoning. CONCLUSIONS: The Eastern Mediterranean basin is an unusual region and the rabbitfish an unusual source for ciguatera poisoning. There are no readily available and reliable means for detecting ciguatoxin in humans. A high index of suspicion is needed for diagnosis and a thorough differential diagnosis is essential to eliminate other poisonings, decompression sickness and encephalitis. Supportive therapy is the mainstay of treatment.- - - - - - - - - - ranking = 3.7373514332161E-5keywords = muscle (Clic here for more details about this article) |
6/23. neuroleptic malignant syndrome due to olanzapine.neuroleptic malignant syndrome (NMS) is a rare and potentially fatal complication precipitated by the use of antipsychotic medications, most notably haloperidol. Criteria previously described include: exposure to the neuroleptic class of medications; hyperthermia; muscle rigidity; a cluster of laboratory and physical findings that may include mental status changes, autonomic instability, creatine phosphokinase elevation and leukocytosis, and exclusion of other causes for the patient's condition. A prodrome of mental status changes, autonomic instability, tremors, diaphoresis, excess salivation, and extrapyramidal signs may precede NMS. Prior reports of NMS linked to olanzapine have been in patients who had been previously treated with other neuroleptic agents or in patients who had previous episodes of NMS precipitated by other neuroleptics. Several cases included patients treated with olanzapine in addition to another neuroleptic. This report describes a case of NMS associated with olanzapine in a patient who had not previously been exposed to the neuroleptic drug class. At the time this patient presented, there were no reports in the literature of NMS associated with olanzapine alone. Treatment of NMS includes: immediate withdrawal of all neuroleptics; supportive care; fever control; management of autonomic instability (tachycardia, tachypnea, blood pressure fluctuations); and pharmacologic management with dantrolene and bromocriptine.- - - - - - - - - - ranking = 0.44090410670657keywords = rigidity, extrapyramidal, muscle (Clic here for more details about this article) |
7/23. Early recognition of neuroleptic malignant syndrome during traumatic brain injury rehabilitation.neuroleptic malignant syndrome is a rare disorder that manifests with hyperthermia, muscle rigidity and autonomic instability. Presented is a case series of individuals with traumatic brain injury and agitation who, when treated with neuroleptics, developed neuroleptic malignant syndrome. Although the incidence of this syndrome is rare, it is associated with significant morbidity and mortality. The onset of symptoms inconsistent with the patient's current level of recovery should alert the clinician to consider other possible diagnosis and failure to distinguish the features of neuroleptic malignant syndrome from post-traumatic agitation will delay appropriate intervention for this potentially life-threatening disorder.- - - - - - - - - - ranking = 0.29804696384942keywords = rigidity, muscle (Clic here for more details about this article) |
8/23. Extrapyramidal side effects of antiemetics presenting as psychiatric illness.Although extrapyramidal side effects of two commonly used antiemetics, metoclopramide and prochlorperazine, are well known, it may be difficult for even the experienced practitioner to distinguish some of these extrapyramidal reactions from such psychiatric symptoms as anxiety, depression, or catatonia. Certain patient groups have increased susceptibility to these extrapyramidal reactions, including patients under 30, those with AIDS, those with renal disease, oncology patients, and possibly women. physicians should maintain a high index of suspicion for depression, anxiety, or catatonia if their patients are taking antiemetics. These symptoms may be extrapyramidal side effects of the antiemetic rather than indications of a primary mental disorder.- - - - - - - - - - ranking = 0.57142857142857keywords = extrapyramidal (Clic here for more details about this article) |
9/23. Quetiapine in the treatment of behavioral disturbances in patients with Huntington's disease.The effect of quetiapine (an atypical antipsychotic with minimal extrapyramidal side effects) on motor as well as behavioral symptoms was studied in five consecutive patients with Huntington's disease in a long-term facility. Improvement of behavioral symptoms (i.e., psychotic symptoms, agitation, irritability, and insomnia) without worsening of motor functioning were noted.- - - - - - - - - - ranking = 0.14285714285714keywords = extrapyramidal (Clic here for more details about this article) |
10/23. brachial plexus palsy with the use of haloperidol and a geriatric chair.An 81-year-old white man was admitted to an intermediate care facility because of increased wandering and confusion secondary to dementia. On the first day after admission, the patient tried to leave the facility and was hitting and kicking the employees. haloperidol 0.5 mg tid was prescribed to help control his behavior. He became more agitated and confused; haloperidol was then increased to 1 mg qid and the patient was confined to a geriatric chair to prevent injuries. Cogwheel movements, rigidity, and marked sedation were documented. A right brachial plexus palsy was diagnosed. This case demonstrated the hazards of two commonly used interventions in a nursing home: antipsychotic agents and the geriatric chair.- - - - - - - - - - ranking = 0.29800959033509keywords = rigidity (Clic here for more details about this article) |
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