Doctor, What Else Can You Do For My Wife?

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Conclusion:Most Likely Diagnosis in Our Patient is stillNeuroleptic Malignant Syndrome (NMS)Risperidone is the causative agentImportanceHistory & Physical Examination inDistinguishing the Diagnosis
Neuroleptic Malignant SyndromeDiscussion:(NMS)• Uncommon but potentially life-threateningidiosyncratic adverse drug reaction after:– Anti-psychotic (typical/atypical) treatment– Sudden withdrawal of dopaminergic agents• Unpredictable course• High morbidity & mortalityTreatment in Psychiatry: Neuroleptic Malignant Syndrome. Am J Psychiatry164:6, June 2007
Page 1 and 2:
Doctor,What else can You do for My
Page 3 and 4:
Madam Tang• Past Medical History:
Page 5 and 6:
Day 1Transfer from Psychiatric Unit
Page 7 and 8: Day 1Special Observation Ward• Af
Page 9 and 10: Day 2Transfer to Cohort Ward• Tra
Page 12 and 13: Discussion:What are the Differentia
Page 14 and 15: Day 1-2Investigations• Complete B
Page 16 and 17: Day 2ECG
Page 18 and 19: Day 2Chest X-Ray
Page 20 and 21: Day 2CT Brain (Plain) Report• No
Page 22 and 23: Day 1-4Temperature ChartD1 D2 D3 D4
Page 24 and 25: Summary / Problemsat this Juncture1
Page 26 and 27: Day 5Lumbar Puncture• Lumbar Punc
Page 28 and 29: Day 1-9Temperature ChartD1 D2 D3 D4
Page 30 and 31: Day 8Septic Workup• Sputum cultur
Page 32 and 33: Day 8Advice fromInfectious Disease
Page 34 and 35: Day 11-15Temperature ChartD11 D12 D
Page 36 and 37: Day 10Patient Reviewed Again• Fev
Page 38 and 39: 23Discussion:What are the Different
Page 40 and 41: Discussion:What else Can We Do?•
Page 42 and 43: Discussion:NMS: Clinical Features
Page 44 and 45: Day 10The Clinical Picture is Compa
Page 46 and 47: Day 5-8Blood Pressure/Pulse ChartHy
Page 48 and 49: Discussion:Is Elevated Creatine Kin
Page 50 and 51: Day 1-10Temperature ChartD1 D2 D3 D
Page 52 and 53: Discussion:What else Can We Do?Can
Page 54 and 55: Day 10Drug Record in Our PatientFlu
Page 56 and 57: Discussion:Why is so Important to D
Page 60 and 61: Discussion:NMS: Epidemiology• Inc
Page 62 and 63: Discussion:Why does this Patient be
Page 64 and 65: Discussion:What is So Special in Ou
Page 66 and 67: Discussion:NMS in Elderlyhttp://hk.
Page 68 and 69: Discussion:NMS in Elderly• Increa
Page 70 and 71: Discussion:Why does our Patient wit
Page 72 and 73: Discussion:Treatment of NMS• Mild
Page 74 and 75: Discussion:Treatment of NMS:Dantrol
Page 76 and 77: Day 11-22Temperature ChartD11 D12 D
Page 78 and 79: Day 12-24Progress• Physiotherapy:
Page 80 and 81: Day 35Progress inConvalescent Hospi
Page 82 and 83: Day 103Discharge• Upon Discharge-
Page 84 and 85: Discussion:SUMMARYWhat Have I Learn
Page 86 and 87: Discussion:What Have I Learned from
Page 88 and 89: After Discharge• Followed Up in M
Page 90 and 91: Discussion:Anti-Psychotics in Elder
Page 92 and 93: Discussion:NMS after Anti-Psychotic
Page 94 and 95: Discussion:Age-Related Physiologica
Page 96 and 97: Discussion:NMS in ElderlyNeurolepti
Page 98 and 99: Day 2Abdominal X-Ray
Page 100 and 101: Discussion:What are the Differentia
Page 102 and 103: Day 5Lumbar Puncture• Lumbar Punc
Page 104 and 105: Typical vs. Atypical Anti-Psychotic
Page 106 and 107: Discussion:Risk Factors of NMS• D
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Doctor, What Else Can You Do For My Wife?

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