Acute Parkinsonism

  • Hubert H. Fernandez
  • Joseph H. Friedman
Part of the Current Clinical Neurology book series (CCNEU)


Patient 1: A 75-year-old woman with a history of bipolar affective illness dating back to her 20s was admitted to the hospital after falling and breaking her hip while walking her dog. She had been living alone. She underwent a total hip replacement without incident and was at her mental and physical baseline in the recovery room and then on the postsurgical floor. Two days after surgery she suddenly became mute, stiff, and unresponsive. In addition to her usual regimen of 600 mg lithium, 20 mg fluoxetine, and 4 mg trifluoperazine daily, she had received five doses of meperidine (50 mg/bolus intravenously) for pain control. She kept her eyes open and responded to visual threat and deep pain but not voice. She had markedly increased tone and was akinetic. When her arms were elevated, she slowly lowered them. Deep tendon reflexes were normal. Physical examination, vital signs, laboratory tests, including lithium levels and head computed tomography (CT) were unremarkable. She remained in this state for 3 days before a movement disorder consultation was requested.


Neurol Neurosurg Psychiatry Neuroleptic Malignant Syndrome Viral Encephalitis Encephalitis Lethargica Akinetic Mutism 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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Copyright information

© Humana Press Inc. 2005

Authors and Affiliations

  • Hubert H. Fernandez
    • 1
  • Joseph H. Friedman
    • 1
  1. 1.Department of Clinical NeurosciencesBrown University School of MedicineProvidence

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