Limits...
Elevated creatine kinase does not necessarily correspond temporally with onset of muscle rigidity in neuroleptic malignant syndrome: a report of two cases.

Nisijima K - Neuropsychiatr Dis Treat (2012)

Bottom Line: Serum creatine kinase (CK) elevation occurs in over 90% of cases.However, in some exceptional cases, CK elevation and emergence of muscle rigidity do not appear in the same stage, making early diagnosis of neuroleptic malignant syndrome more difficult.Two rare cases of neuroleptic malignant syndrome are presented in which elevated serum CK and emergence of muscle rigidity did not occur in the same stage of neuroleptic malignant syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Jichi Medical University, Tochigi, Japan.

ABSTRACT
Neuroleptic malignant syndrome is an uncommon but dangerous complication of antipsychotic drugs, characterized by clinical symptoms that include hyperthermia, severe muscle rigidity, autonomic dysfunction, and altered mental state. Serum creatine kinase (CK) elevation occurs in over 90% of cases. Many diagnostic criteria sets for neuroleptic malignant syndrome have been proposed, all of which include hyperthermia and muscle rigidity as major symptoms, and serum CK elevation as either a major or minor symptom. In general, elevated CK occurs in the initial stage of neuroleptic malignant syndrome and corresponds temporally with the onset of muscle rigidity. However, in some exceptional cases, CK elevation and emergence of muscle rigidity do not appear in the same stage, making early diagnosis of neuroleptic malignant syndrome more difficult. Two rare cases of neuroleptic malignant syndrome are presented in which elevated serum CK and emergence of muscle rigidity did not occur in the same stage of neuroleptic malignant syndrome. An elevated CK level is common in the early stage of neuroleptic malignant syndrome, suggesting that serum CK elevation is a useful indicator for early detection of neuroleptic malignant syndrome. However, a definitive diagnosis of neuroleptic malignant syndrome must be determined from the presence of specific clinical symptoms.

No MeSH data available.


Related in: MedlinePlus

Changes in serum creatine kinase level, muscle rigidity, and body temperature in case 1 (A) and case 2 (B).Notes: Both patients with neuroleptic malignant syndrome showed nonsimultaneous occurrence of elevated serum creatine kinase (●) and onset of muscle rigidity (■).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC3526146&req=5

f1-ndt-8-615: Changes in serum creatine kinase level, muscle rigidity, and body temperature in case 1 (A) and case 2 (B).Notes: Both patients with neuroleptic malignant syndrome showed nonsimultaneous occurrence of elevated serum creatine kinase (●) and onset of muscle rigidity (■).

Mentions: To monitor changes in muscle rigidity and serum CK values more accurately, the NMS evaluation scale proposed by Sachdev10 was used. Muscle rigidity was rated as follows: 0, nil (no rigidity); 1, mild (slight rigidity present, particularly obvious on recruitment of muscles with jaw clenching); 2, moderate (definitely present to a significant degree but produces no limitation of passive movement); or 3, severe (rigidity that produces some limitation of passive movement). The changes in these values during the course of NMS were monitored, and changes in serum CK levels and body temperature were also assessed. These data are shown in Figure 1A.


Elevated creatine kinase does not necessarily correspond temporally with onset of muscle rigidity in neuroleptic malignant syndrome: a report of two cases.

Nisijima K - Neuropsychiatr Dis Treat (2012)

Changes in serum creatine kinase level, muscle rigidity, and body temperature in case 1 (A) and case 2 (B).Notes: Both patients with neuroleptic malignant syndrome showed nonsimultaneous occurrence of elevated serum creatine kinase (●) and onset of muscle rigidity (■).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3526146&req=5

f1-ndt-8-615: Changes in serum creatine kinase level, muscle rigidity, and body temperature in case 1 (A) and case 2 (B).Notes: Both patients with neuroleptic malignant syndrome showed nonsimultaneous occurrence of elevated serum creatine kinase (●) and onset of muscle rigidity (■).
Mentions: To monitor changes in muscle rigidity and serum CK values more accurately, the NMS evaluation scale proposed by Sachdev10 was used. Muscle rigidity was rated as follows: 0, nil (no rigidity); 1, mild (slight rigidity present, particularly obvious on recruitment of muscles with jaw clenching); 2, moderate (definitely present to a significant degree but produces no limitation of passive movement); or 3, severe (rigidity that produces some limitation of passive movement). The changes in these values during the course of NMS were monitored, and changes in serum CK levels and body temperature were also assessed. These data are shown in Figure 1A.

Bottom Line: Serum creatine kinase (CK) elevation occurs in over 90% of cases.However, in some exceptional cases, CK elevation and emergence of muscle rigidity do not appear in the same stage, making early diagnosis of neuroleptic malignant syndrome more difficult.Two rare cases of neuroleptic malignant syndrome are presented in which elevated serum CK and emergence of muscle rigidity did not occur in the same stage of neuroleptic malignant syndrome.

View Article: PubMed Central - PubMed

Affiliation: Department of Psychiatry, Jichi Medical University, Tochigi, Japan.

ABSTRACT
Neuroleptic malignant syndrome is an uncommon but dangerous complication of antipsychotic drugs, characterized by clinical symptoms that include hyperthermia, severe muscle rigidity, autonomic dysfunction, and altered mental state. Serum creatine kinase (CK) elevation occurs in over 90% of cases. Many diagnostic criteria sets for neuroleptic malignant syndrome have been proposed, all of which include hyperthermia and muscle rigidity as major symptoms, and serum CK elevation as either a major or minor symptom. In general, elevated CK occurs in the initial stage of neuroleptic malignant syndrome and corresponds temporally with the onset of muscle rigidity. However, in some exceptional cases, CK elevation and emergence of muscle rigidity do not appear in the same stage, making early diagnosis of neuroleptic malignant syndrome more difficult. Two rare cases of neuroleptic malignant syndrome are presented in which elevated serum CK and emergence of muscle rigidity did not occur in the same stage of neuroleptic malignant syndrome. An elevated CK level is common in the early stage of neuroleptic malignant syndrome, suggesting that serum CK elevation is a useful indicator for early detection of neuroleptic malignant syndrome. However, a definitive diagnosis of neuroleptic malignant syndrome must be determined from the presence of specific clinical symptoms.

No MeSH data available.


Related in: MedlinePlus