Teaching points

1	In clinical practice NMS does not present as a clear and easily distinguishable syndrome.
2	Recognition and treatment of NMS needs to be immediate and as early as possible, even before reaching all diagnostic criteria to prevent mortality and morbidity.
3	NMS always needs to be kept in mind after administering a high potency antipsychotic when developing signs of rigidity regardless of autonomic instability.
4	Creatinine kinase is an inexpensive test and should be ordered sooner rather than later.
5	Differential diagnosis to NMS after ruling out medical causes: acute psychosis, severe depression, serotonin syndrome (SS), malignant hyperthermia, and malignant catatonia.