Neuroleptic malignant syndrome (4)

• Pyrexia - mild to severe (38-41 C)

• Rigidity - "lead pipe" rigidity but also cog-wheeling, akinesia, dyskinesia, waxy flexibility

• Impaired consciousness - stupor, coma, mutism, delirium, catatonia

• Autonomic instability - tachycardia, blood pressure disturbance

• Raised muscle and liver enzymes - CK, LD, ALT, AST

• Leucocytosis

• Low iron

• Serotonergic syndrome

• Malignant hyperthermia

• But may overlap with acute lethal catatonia