RT Journal Article
SR Electronic
T1 Atypical neuroleptic malignant syndrome and non-alcoholic Wernicke’s encephalopathy
JF BMJ Case Reports
JO BMJ Case Reports
FD BMJ Publishing Group Ltd
SP e244082
DO 10.1136/bcr-2021-244082
VO 14
IS 8
A1 Esther Shan Lin Hor
A1 Gurpreet Pal Singh
A1 Nurul Akhmar Omar
A1 Vincent Russell
YR 2021
UL http://casereports.bmj.com/content/14/8/e244082.abstract
AB We report the case of a middle-aged woman with a history of bipolar disorder, in the absence of alcohol or substance misuse. The patient had been maintained on fluphenazine decanoate depot and now presented acutely with cognitive dysfunction and rigidity. Laboratory tests revealed elevated creatine kinase, acute kidney injury with metabolic acidosis and transaminitis, leading to a provisional diagnosis of neuroleptic malignant syndrome (NMS). Neuroleptics were withheld; dialysis was commenced; and blood biochemistry parameters improved in tandem. However, mental status changes persisted, and re-evaluation revealed multidirectional nystagmus with bilateral past-pointing. MRI confirmed the diagnosis of Wernicke’s encephalopathy (WE). Prompt recovery followed treatment with high-dose intravenous thiamine. We discuss the co-occurrence of NMS and non-alcoholic WE—highlighting the need for a high index of suspicion for these relatively rare neuropsychiatric diagnoses which are often missed in those with atypical presentations.