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Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal reaction to antipsychotic medications characterized by hyperthermia, muscle rigidity, altered mental status, and autonomic dysfunction. It typically occurs within days to weeks of initiating or increasing the dose of dopamine-blocking agents, with mortality rates of 10-20% if untreated.
NMS results from severe dopamine receptor blockade in the basal ganglia and hypothalamus, leading to impaired thermoregulation and muscle rigidity. The sudden reduction in dopaminergic activity disrupts normal temperature control mechanisms and causes widespread muscle contractions, generating excessive heat and metabolic stress.
Early recognition requires high clinical suspicion in patients taking antipsychotics who develop the classic tetrad of fever, rigidity, altered consciousness, and autonomic instability. Laboratory findings including elevated creatine kinase, leukocytosis, and metabolic acidosis support the diagnosis, while immediate discontinuation of the offending agent and supportive care with cooling measures and muscle relaxants are critical for survival.