Neuroleptic Malignant Syndrome(NMS), first named by Delay and Deniker, is a fatal illness characterized by muscular rigidity, hyperthermia, catatonic stupor and autonomic dysfunctions. Although Delay and Deniker suggest that respiratory insufficiency is a cardinal feature, it seems probable that respiratory distress associated with pneumonia is a secondary complication resulting from dysphagia. The pathogenesis of NMS is unclear. But the various signs of NMS can be explained as disorders of hypothalamus, basal ganglia and brain stem functions. A possible link between NMS and acute lethal catatonia had been noted. And several authors discussed the relationship of this syndrome to malignant hyperpyrexia, in which the use of inhalated anesthetics or muscle relaxants precipitates tachycardia, tachypnea, rapid temperature elevation and muscular rigidity. The authors present four cases of possible NMS. Their detailed clinical features and outcomes are reported here with a brief review of therapeutic explorations
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