Summary
The case of a young female patient with neuroleptic malignant syndrome (NMS) and extended MRI white matter hyperintensity in the left parietal and both occipital lobes is reported. MRI lesions resembled findings in hypertensive encephalopathy, they were not readily compatible with CNS vasculitis. Venous sinus thrombosis could be ruled out. Vascular encephalopathy with transient white matter edema and a small residual left parietal lesion is suggested. Neurochemical implications are discussed with particular reference to a possible involvement of excitatory amino acids in NMS pathogenesis.
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References
Addonizio G, Susman VL, Roth SD (1987) Neuroleptic malignant syndrome: review and analysis of 115 cases. Biol Psychiatry 22: 1004–1020
Baca L, Martinelli L (1990) Neuroleptic malignant syndrome: a unique association with a tricyclic antidepressant. Neurology 40: 1797–1798
Bunney WE, Garland BL (1983) Possible receptor effects of chronic lithium administration. Neuropharmacology 22: 367–372
Buonanno FS, Moody DM, Ball MR, Wayne Laster D (1978) Computed cranial tomographic findings in cerebral sinovenous occlusion. J Comput Assist Tomogr 2: 281–290
Coffey CE, Ross DR (1980) Treatment of lithium/neuroleptic neurotoxicity during lithium maintenance. Am J Psychiatry 137: 736–737
Cohen WJ, Cohen NH (1974) Lithium carbonate, haloperidol, and irreversible brain damage. J Am Med Assoc 230: 1283–1287
Coughlin WF, McMurdo SK, Reeves T (1989) MR imaging of postpartum cortical blindness. J Comput Assist Tomogr 13: 572–576
Davis JM, Sakkas P, Hua J (1990) Remarks on neuroleptic malignant syndrome after a review of the first 500 cases. In: Stefanis CN, Rabavilas AD, Soldatos CR (eds) Psychiatry: a world perspective, vol 3. Excerpta Medica, Amsterdam New York Oxford, pp 262–267
Ford LM, Sanberg PR, Norman AB, Fogelson MH (1989) MK-801 prevents hippocampal neurodegeneration in neonatal hypoxic-ischemic rats. Arch Neurol 46: 1090–1096
de Groen PC, Aksamit AJ, Rakela J, Forbes GS, Krom RAF (1987) Central nervous system toxicity after liver transplantation. The role of cyclosporine and cholesterol. N Engl J Med 317: 861–866
Greenan TJ, Grossman RI, Goldberg HI (1992) Cerebral vasculitis: MR imaging and angiographic correlation. Radiology 182: 65–72
Halman M, Goldbloom DS (1990) Fluoxetine and neuroleptic malignant syndrome. Biol Psychiatry 28: 518–521
Hauser RA, Lacey M, Knight R (1988) Hypertensive encephalopathy. Magnetic resonance imaging demonstration of reversible cortical and white matter lesions. Arch Neurol 45: 1078–1083
Horn E, Lach B, Lapierre Y, Hrdina P (1988) Hypothalamic pathology in the neuroleptic malignant syndrome. Am J Psychiatry 145: 617–620
Jones EM, Dawson A (1989) Neuroleptic malignant syndrome: a case report with postmortem brain and muscle pathology. J Neurol Neurosurg Psychiatry 52: 1006–1009
Keck PE, Pope HG, Cohen BM, McElroy SL, Nierenberg AA (1989) Risk factors for neuroleptic malignant syndrome. Arch Gen Psychiatry 46: 914–918
Kochhar A, Zivin JA, Lyden PD, Mazzarella V (1988) Glutamate antagonist therapy reduces neurologic deficits produced by focal central nervous system ischemia. Arch Neurol 45: 148–153
Kwong YL, Yu YL, Lam KSL, Woo E, Ma JTC, Huang CY (1987) CT appearance in hypertensive encephalopathy. Neuroradiology 29: 215
Lee S, Merriam A, Kim TS, Liebling M, Dickson DW, Moore GRW (1989) Cerebellar degeneration in neuroleptic malignant syndrome: neuropathologic findings and review of the literature concerning heat-related nervous system injury. J Neurol Neurosurg Psychiatry 52: 387–391
Lewis LK, Hinshaw DB, Will AD, Hasso AN, Thompson JR (1988) CT and angiographic correlation of severe neurological disease in toxemia of pregnancy. Neuroradiology 30: 59–64
Miller DD, Sharafuddin MJA, Kathol RG (1991) A case of clozapine-induced neuroleptic malignant syndrome. J Clin Psychiatry 52: 99–101
Moore PM, Fauci AS (1981) Neurologic manifestations of systemic vasculitis. A retrospective and prospective study of the clinicopathologic features and responses to therapy in 25 patients. Am J Med 71: 517–524
Müller T, Becker T, Fritze J (1988) Neuroleptic malignant syndrome after clozapine plus carbamazepine. Lancet ii: 1500
Olney JW (1991) Excitotoxicity and neuropsychiatric disorders. In: Ascher P, Choi DW, Christen Y (eds) Glutamate, cell death and memory. Springer, Berlin Heidelberg New York Tokyo, pp 77–101
Rail DL, Perkin GD (1980) Computerized tomographic appearance of hypertensive encephalopathy. Arch Neurol 37: 310–311
Richards A, Graham D, Bullock R (1988) Clinicopathological study of neurological complications due to hypertensive disorders of pregnancy. J Neurol Neurosurg Psychiatry 51: 416–421
Sawada H, Udaka F, Seriu N, Shindou K, Kameyama M, Tsujimura M (1990) MRI demonstration of cortical laminar necrosis and delayed white matter injury in anoxic encephalopathy. Neuroradiology 32: 319–321
Shalev A, Munitz H (1986) The neuroleptic malignant syndrome: agent and host interaction. Acta Psychiatr Scand 73: 337–347
Simpson DM, Davis GC (1984) Case report on neuroleptic malignant syndrome associated with withdrawal from amantadine. Am J Psychiatry 141: 796–797
Truwit CL, Denaro CP, Lake JR, DeMarco T (1991) MR imaging of reversible cyclosporin A-induced neurotoxicity. Am J Neuroradiology 12: 651–659
Vandenplas O, Dive A, Dooms G, Mahieu P (1990) Magnetic resonance evaluation of severe neurological disorders in eclampsia. Neuroradiology 32: 47–49
Weller M, Kornhuber J (1992 a) NMDA antagonists, schizophrenia, and neuroleptic malignant syndrome (letter). Arch Neurol (in press)
Weller M, Kornhuber J (1992 b) A rationale for NMDA receptor antagonist therapy of the neuroleptic malignant syndrome. Med Hypothesis (in press)
Zivin JA, Mazzarella V (1991) Tissue plasminogen activator plus glutamate antagonist improves outcome after embolic stroke. Arch Neurol 48: 1235–1238
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Becker, T., Kornhuber, J., Hofmann, E. et al. MRI white matter hyperintensity in neuroleptic malignant syndrome (NMS)—a clue to pathogenesis?. J. Neural Transmission 90, 151–159 (1992). https://doi.org/10.1007/BF01250797
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DOI: https://doi.org/10.1007/BF01250797