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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1989 Mar;52(3):387–391. doi: 10.1136/jnnp.52.3.387

Cerebellar degeneration in neuroleptic malignant syndrome: neuropathologic findings and review of the literature concerning heat-related nervous system injury.

S Lee 1, A Merriam 1, T S Kim 1, M Liebling 1, D W Dickson 1, G R Moore 1
PMCID: PMC1032416  PMID: 2647908

Abstract

A selective subtotal cerebellar neuronal degeneration was found in a patient who died 4 1/2 months after suffering neuroleptic malignant syndrome (NMS), a rare, potentially fatal disorder associated with neuroleptic medications. It is suggested that the cerebellar neuronal degeneration in this case was due to hyperpyrexia, a cardinal clinical feature of NMS. Similar pathologic findings appear not to have been previously reported in NMS but have been described in heat-induced central nervous system (CNS) injury. The findings imply that a cerebellar syndrome might be encountered in patients who survive NMS complicated by a particularly high febrile course.

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Selected References

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  1. Addonizio G., Susman V. L., Roth S. D. Neuroleptic malignant syndrome: review and analysis of 115 cases. Biol Psychiatry. 1987 Aug;22(8):1004–1020. doi: 10.1016/0006-3223(87)90010-2. [DOI] [PubMed] [Google Scholar]
  2. Araki M., Takagi A., Higuchi I., Sugita H. Neuroleptic malignant syndrome: caffeine contracture of single muscle fibers and muscle pathology. Neurology. 1988 Feb;38(2):297–301. doi: 10.1212/wnl.38.2.297. [DOI] [PubMed] [Google Scholar]
  3. Burke R. E., Fahn S., Mayeux R., Weinberg H., Louis K., Willner J. H. Neuroleptic malignant syndrome caused by dopamine-depleting drugs in a patient with Huntington disease. Neurology. 1981 Aug;31(8):1022–1025. doi: 10.1212/wnl.31.8.1022. [DOI] [PubMed] [Google Scholar]
  4. Delgado G., Tuñn T., Gállego J., Villanueva J. A. Spinal cord lesions in heat stroke. J Neurol Neurosurg Psychiatry. 1985 Oct;48(10):1065–1067. doi: 10.1136/jnnp.48.10.1065. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Downey G. P., Rosenberg M., Caroff S., Beck S., Rosenberg H., Gerber J. C., Heiman-Patterson T. D., Aronson M. D. Neuroleptic malignant syndrome. Patient with unique clinical and physiologic features. Am J Med. 1984 Aug;77(2):338–340. doi: 10.1016/0002-9343(84)90716-2. [DOI] [PubMed] [Google Scholar]
  6. GORE I., ISAACSON N. H. The pathology of hyperpyrexia; observations at autopsy in 17 cases of fever therapy. Am J Pathol. 1949 Sep;25(5):1029–1059. [PMC free article] [PubMed] [Google Scholar]
  7. Lefkowitz D., Ford C. S., Rich C., Biller J., McHenry L. C., Jr Cerebellar syndrome following neuroleptic induced heat stroke. J Neurol Neurosurg Psychiatry. 1983 Feb;46(2):183–185. doi: 10.1136/jnnp.46.2.183. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Mehta A. C., Baker R. N. Persistent neurological deficits in heat stroke. Neurology. 1970 Apr;20(4):336–340. doi: 10.1212/wnl.20.4.336. [DOI] [PubMed] [Google Scholar]
  9. Morris H. H., 3rd, McCormick W. F., Reinarz J. A. Neuroleptic malignant syndrome. Arch Neurol. 1980 Jul;37(7):462–463. doi: 10.1001/archneur.1980.00500560092019. [DOI] [PubMed] [Google Scholar]
  10. Reis J., Felten P., Rumbach L., Collard M. Hyperthermie avec rhabdomyolyse aiguë chez un psychotique traité par neuroleptiques. Rev Neurol (Paris) 1983;139(10):595–596. [PubMed] [Google Scholar]
  11. Richter W. W., Issinger O. G. Differential heat shock response of primary human cell cultures and established cell lines. Biochem Biophys Res Commun. 1986 Nov 26;141(1):46–52. doi: 10.1016/s0006-291x(86)80332-1. [DOI] [PubMed] [Google Scholar]
  12. SILVERMAN J. J., WILSON J. E. An unusual complication following thyroidectomy: heatstroke with permanent cerebellar damage. Ann Intern Med. 1950 Oct;33(4):1036–1041. doi: 10.7326/0003-4819-33-4-1036. [DOI] [PubMed] [Google Scholar]
  13. Shibolet S., Coll R., Gilat T., Sohar E. Heatstroke: its clinical picture and mechanism in 36 cases. Q J Med. 1967 Oct;36(144):525–548. [PubMed] [Google Scholar]
  14. Sprang G. K., Brown I. R. Selective induction of a heat shock gene in fibre tracts and cerebellar neurons of the rabbit brain detected by in situ hybridization. Brain Res. 1987 Dec;427(1):89–93. doi: 10.1016/0169-328x(87)90049-0. [DOI] [PubMed] [Google Scholar]
  15. Yaqub B. A., Al-Harthi S. S., Al-Orainey I. O., Laajam M. A., Obeid M. T. Heat stroke at the Mekkah pilgrimage: clinical characteristics and course of 30 patients. Q J Med. 1986 May;59(229):523–530. [PubMed] [Google Scholar]
  16. Yaqub B. A., Daif A. K., Panayiotopoulos C. P. Pancerebellar syndrome in heat stroke: clinical course and CT scan findings. Neuroradiology. 1987;29(3):294–296. doi: 10.1007/BF00451771. [DOI] [PubMed] [Google Scholar]
  17. Zelman S., Guillan R. Heat stroke in phenothiazine-treated patients: a report of three fatalities. Am J Psychiatry. 1970 Jun;126(12):1787–1790. doi: 10.1176/ajp.126.12.1787. [DOI] [PubMed] [Google Scholar]

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