Sheil Amy T, Collins Kim A, Schandl Cynthia A, Harley Russell A
Medical University of South Carolina, Charleston, South Carolina, USA.
Am J Forensic Med Pathol. 2007 Jun;28(2):116-20. doi: 10.1097/PAF.0b013e31805c93d0.
Neuroleptic malignant syndrome (NMS) is a diagnosis of exclusion difficult to make due to a lack of pathognomonic features. Diagnosing NMS by postmortem examination becomes increasingly challenging when possible underlying brain pathology is obscured. The diagnosis is based on clinical history and laboratory findings. Autopsy and histologic findings, if any, usually are reflective of hyperthermia or complications (eg, aspiration pneumonia) of NMS. The authors describe a case of a 36-year-old Hispanic woman with a presumptive diagnosis of pseudoseizures, treated with various combinations of neuroleptic medications over a 6-week period prior to her sudden, unexpected, in-hospital death. Neuroleptic malignant syndrome is likely to have contributed to this patient's death. Confounding factors and medicolegal issues of a postmortem diagnosis of NMS are discussed.
抗精神病药恶性综合征（NMS）是一种排除性诊断，由于缺乏特异性特征而难以做出。当可能存在的潜在脑部病变不明确时，通过尸检诊断NMS变得越来越具有挑战性。诊断基于临床病史和实验室检查结果。尸检和组织学检查结果（如果有的话）通常反映NMS的高热或并发症（如吸入性肺炎）。作者描述了一例36岁西班牙裔女性病例，该患者初步诊断为假性癫痫，在突然意外死于医院之前的6周内接受了多种抗精神病药物联合治疗。抗精神病药恶性综合征很可能导致了该患者的死亡。本文讨论了NMS尸检诊断的混杂因素和法医学问题。
