A Validation of the Tarlov Cyst Quality-of-Life Scale in Patients Surgically Treated for Intrasacral Meningoceles.

Neuroleptic malignant syndrome (NMS) is a rare but potentially life-threatening neurologic emergency associated with dopamine receptor antagonists, including both first- and second-generation antipsychotics. The reported incidence ranges from 0.02% to 3% among patients receiving antipsychotic therapy [,].  NMS is classically defined by a tetrad of symptoms: altered mental status, muscle rigidity, hyperthermia, and autonomic instability. Heart, pulmonary, renal, musculoskeletal, and other systems are also affected by NMS complications. Usually, more than one-third of patients need to be treated in an intensive care unit []. In terms of management, all antipsychotics, dopamine-depleting, and dopamine-antagonistic medications should be stopped immediately, and intensive care should be given on a medical ward. All other psychotropic medications should be discontinued []. It is important to monitor and treat abnormalities in fluid/electrolyte balance, especially hyperkalemia, acid-base balance, cardiorespiratory function, rhabdomyolysis, renal function, level of awareness, and thromboembolic phenomena []. Rhabdomyolysis was the most common complication (30.1%). Sepsis (6.2%), acute renal injury (17.7%), acute respiratory failure (16.1%), and other systemic infections were additional frequent consequences. The unadjusted mortality rate was 5.6% []. However, atypical presentations lacking one or more of these hallmark features-particularly hyperthermia or rigidity-have been increasingly reported []. Milder or incomplete (“forme fruste”) presentations may occur, especially with second-generation antipsychotics or early recognition. In such cases, rigidity may be minimal or absent, and fever-traditionally considered a core diagnostic feature-may not be present. Isolated findings such as autonomic instability or elevated creatine kinase (CK) may not independently suggest NMS, contributing to diagnostic uncertainty [].