Vena Jason, Dufel Susan, Paige Todd
Department of Trauma/EMS, University of Connecticut and Hartford Hospital, 80 Seymour Street, Hartford, CT 06102, USA.
J Emerg Med. 2006 Apr;30(3):311-7. doi: 10.1016/j.jemermed.2005.03.019.
The patient with acute extrapyramidal signs and symptoms presents a significant clinical challenge. We present the case of a young man who developed an acute akathisia and dystonia after inadvertent overdose of olanzapine (Zyprexa) in the setting of a recent discontinuation of fluoxetine. The receptor chemistry and mechanisms pertinent to his presentation are reviewed. An analysis of the literature indicates that a broad incidence range is cited for the extrapyramidal effects of these medications. We suggest a diagnostic and therapeutic approach to the undifferentiated patient presenting with extrapyramidal signs and symptoms. The possibility of neuroleptic malignant syndrome (NMS), serotonin syndrome (SS), tricyclic overdose, and cocaine abuse should be considered in a patient with extrapyramidal signs and symptoms, given the potential for complications. An emphasis is placed on the need for carefully verbalized discharge instructions to avoid a potential untoward outcome.
患有急性锥体外系体征和症状的患者面临着重大的临床挑战。我们报告一例年轻男性病例，该患者在近期停用氟西汀的情况下意外过量服用奥氮平（再普乐）后出现急性静坐不能和肌张力障碍。本文回顾了与他的症状相关的受体化学和机制。文献分析表明，这些药物的锥体外系效应的发生率范围很广。我们提出了一种针对出现锥体外系体征和症状的未分化患者的诊断和治疗方法。鉴于存在并发症的可能性，对于有锥体外系体征和症状的患者，应考虑神经阻滞剂恶性综合征（NMS）、5-羟色胺综合征（SS）、三环类药物过量和可卡因滥用的可能性。重点强调了需要仔细说明出院指导以避免潜在不良后果。
