Korean J Crit Care Med.  2016 Feb;31(1):34-38. 10.4266/kjccm.2016.31.1.34.

Malignant Neuroleptic Syndrome following Deep Brain Stimulation Surgery of Globus Pallidus Pars Internus in Cerebral Palsy

• Lee JM
• Paek SH
• Park HR
• Lee KH
• Shin CW
• Park HY
• Park HP
• Kim DG
• Jeon BS

• KMID: 2227610
• DOI: http://doi.org/10.4266/kjccm.2016.31.1.34

Abstract

Neuroleptic malignant syndrome (NMS) is a rare but potentially lethal outcome caused by sudden discontinuation or dose reduction of dopaminergic agents. We report an extremely rare case of NMS after deep brain stimulation (DBS) surgery in a cerebral palsy (CP) patient without the withdrawal of dopaminergic agents. A 19-year-old girl with CP was admitted for DBS due to medically refractory dystonia and rigidity. Dopaminergic agents were not stopped preoperatively. DBS was performed uneventfully under monitored anesthesia. Dopaminergic medication was continued during the postoperative period. She manifested spasticity and muscle rigidity, and was high fever resistant to anti-pyretic drugs at 2 h postoperative. At postoperative 20 h, she suffered cardiac arrest and expired, despite vigorous cardiopulmonary resuscitation. NMS should be considered for hyperthermia and severe spasticity in CP patients after DBS surgery, irrespective of continued dopaminergic medication.

Keyword

cerebral palsy; deep brain stimulation; neuroleptic malignant syndrome

MeSH Terms

Anesthesia
Cardiopulmonary Resuscitation
Cerebral Palsy*
Deep Brain Stimulation*
Dopamine Agents
Dystonia
Female
Fever
Globus Pallidus*
Heart Arrest
Humans
Muscle Rigidity
Muscle Spasticity
Neuroleptic Malignant Syndrome
Postoperative Period
Young Adult
Dopamine Agents

Figure

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  Fig. 1. Axial (A) and coronal (B) postoperative computed tomography images. There was no intracranial abnormality and electrode leads were in the proper positions.

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  Fig. 2. An X-ray image shows no significant chest abnormality, however it does reveal abdominal air fluid levels suggesting ileus.

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  Fig. 3. A schematic illustration of changes in body temperature and the management of hyperthermia during the perioperative period. BT: body temperature; BP: blood pressure; HR: heart rate; RR: raspiration rate; R-ward: recovery ward; CPR: cardiopulmonary resuscitation; ICU: intensive care unit.

Reference

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