Storm Christian, Gebker Rolf, Krüger Anne, Nibbe Lutz, Schefold Joerg C, Martens Frank, Hasper Dietrich
J Med Case Rep. 2009 Feb 19;3:6170. doi: 10.4076/1752-1947-3-6170.
A rare side effect of antipsychotic medication is neuroleptic malignant syndrome, mainly characterized by hyperthermia, altered mental state, haemodynamic dysregulation, elevated serum creatine kinase and rigor. There may be multi-organ dysfunction including renal and hepatic failure as well as serious rhabdomyolysis, acute respiratory distress syndrome and disseminated intravascular coagulation. The prevalence of neuroleptic malignant syndrome is between 0.02% and 2.44% for patients taking neuroleptics and it is not necessary to fulfil all cardinal features characterizing the syndrome to be diagnosed with neuroleptic malignant syndrome. Because of other different life-threatening diseases matching the various clinical findings, the correct diagnosis can sometimes be hard to make. A special problem of intensive care treatment is the management of severe hyperthermia. Lowering of body temperature, however, may be a major clinical problem because hyperthermia in neuroleptic malignant syndrome is typically unresponsive to antipyretic agents while manual cooling proves difficult due to peripheral vasoconstriction.
A 22-year-old Caucasian man was admitted unconscious with a body temperature of 42 degrees C, elevated serum creatine phosphokinase, tachycardia and hypotonic blood pressure. In addition to intensive care standard therapy for coma and shock, a non-invasive cooling device (Arctic Sun 2000((R)), Medivance Inc., USA), originally designed to induce mild therapeutic hypothermia in patients after cardiopulmonary resuscitation, was used to lower body temperature. After successful treatment it became possible to obtain information from the patient about his recent ambulant treatment with Olanzapin (Zyprexa(R)) for schizophrenia.
Numerous case reports have been published about patients who developed neuroleptic malignant syndrome due to Olanzapin (Zyprexa(R)) medication. Frequently hyperthermia has been observed in these cases with varying outcomes. In our case the only residual impairment for the patient is dysarthria with corresponding symmetric cerebellar pyramidal cell destruction demonstrated by increased signal intensity in T2-weighted magnetic resonance imaging, most likely caused by the excessive hyperthermia.
抗精神病药物的一种罕见副作用是神经阻滞剂恶性综合征，主要特征为高热、精神状态改变、血流动力学失调、血清肌酸激酶升高及肌肉强直。可能存在多器官功能障碍，包括肾衰竭和肝衰竭，以及严重的横纹肌溶解、急性呼吸窘迫综合征和弥散性血管内凝血。服用抗精神病药物的患者中，神经阻滞剂恶性综合征的患病率在0.02%至2.44%之间，诊断神经阻滞剂恶性综合征并不需要具备该综合征的所有主要特征。由于其他不同的危及生命的疾病也有各种与之匹配的临床表现，有时很难做出正确诊断。重症监护治疗的一个特殊问题是严重高热的处理。然而，降低体温可能是一个主要的临床问题，因为神经阻滞剂恶性综合征中的高热通常对抗热药物无反应，而由于外周血管收缩，手动降温也很困难。
一名22岁的白种男性因体温42摄氏度、血清肌酸磷酸激酶升高、心动过速和低血压而昏迷入院。除了针对昏迷和休克的重症监护标准治疗外，还使用了一种非侵入性冷却装置（美国Medivance公司的Arctic Sun 2000((R))），该装置最初设计用于在心肺复苏后诱导患者进行轻度治疗性低温，以降低体温。成功治疗后，得以从患者处了解到他近期因精神分裂症服用奥氮平（再普乐((R))）的门诊治疗情况。
已有大量关于因服用奥氮平（再普乐((R))）而发生神经阻滞剂恶性综合征患者的病例报告。在这些病例中经常观察到高热，且结果各异。在我们的病例中，患者唯一的残留损伤是构音障碍，T2加权磁共振成像显示信号强度增加，提示相应的对称性小脑锥体细胞破坏，很可能是由过度高热所致。
