Malignant neuroleptic syndrome
ICD-10 G21.0 is a billable code used to indicate a diagnosis of malignant neuroleptic syndrome.
Malignant neuroleptic syndrome (MNS) is a life-threatening condition characterized by severe muscle rigidity, hyperthermia, autonomic instability, and altered mental status, typically occurring in patients treated with neuroleptic medications. It is most commonly associated with the use of antipsychotic drugs, particularly in patients with Parkinson's disease or other extrapyramidal disorders. The syndrome can manifest after the initiation of treatment or after dosage increases, and it may also occur following withdrawal of dopaminergic medications. Clinically, MNS is marked by elevated creatine kinase levels, leukocytosis, and metabolic acidosis. The pathophysiology involves dopamine receptor blockade leading to dysregulation of the hypothalamic thermoregulatory center and increased muscle tone. Diagnosis is primarily clinical, supported by laboratory findings, and requires immediate medical intervention to prevent complications such as renal failure or respiratory distress. Management typically includes the cessation of the offending agent, supportive care, and in some cases, the use of medications such as dantrolene or bromocriptine to alleviate symptoms.
Detailed documentation of medication history, clinical symptoms, and treatment response.
Patients presenting with acute agitation or psychosis requiring antipsychotic treatment.
Monitoring for signs of MNS in patients on high-dose or multiple antipsychotic medications.
Comprehensive neurological assessment and documentation of extrapyramidal symptoms.
Patients with Parkinson's disease experiencing exacerbation of symptoms after medication adjustments.
Differentiating MNS from Parkinsonian crises and other movement disorders.
Used when a patient presents with severe symptoms of MNS requiring immediate intervention.
Document the presenting symptoms, history of neuroleptic use, and any interventions performed.
Emergency medicine specialists should be aware of the signs of MNS to ensure timely diagnosis.
Key symptoms include severe muscle rigidity, hyperthermia, autonomic instability, and altered mental status, often following the use of neuroleptic medications.
Diagnosis is primarily clinical, based on the presence of characteristic symptoms and a history of neuroleptic medication use, supported by laboratory findings such as elevated creatine kinase.
Treatment involves immediate cessation of the offending neuroleptic medication, supportive care, and may include medications such as dantrolene or bromocriptine to alleviate symptoms.
