THE NEUROLEPTIC MALIGNANT SYNDROME - A MISSED DIAGNOSIS

The neuroleptic malignant syndrome (NMS) is an idiosyncratic reaction to major tranquilliser drugs characterised by hyperpyrexia, extrapyram idal disorders and altered consciousness. First described in 1968 by D elay and Deniker, early case reports suggested a mortality of between 20 and 30%.1-3 Though the syndrome is now more widely recognised, the diversity of its clinical features may not always be appreciated and m ay lead to diagnostic confusion with other, more common, disorders. We report on two severe cases of NMS: in the first the diagnosis was ini tially thought to be sepsis from a urinary tract infection, and in the second the primary clinical diagnosis was of a mid brain infarction.