Neuroleptic malignant syndrome induced by haloperidol following traumatic brain injury

The use of neuroleptics in the acute management of traumatic brain injury ( TBI) is controversial and may be detrimental to recovery. The following cas e report describes a patient developing neuroleptic malignant syndrome (NMS ) secondary to the use of haloperidol given to control the patient's agitat ion. The patient began to exhibit symptoms consistent with NMS (high fever, dystonia, diaphoresis, tachycardia, and decerebrate posturing) shortly aft er administration of the haloperidol. Upon transfer to a rehabilitation hos pital, the symptoms persisted. When NMS is suspected, the first interventio n is to remove the offending agent; thus, the administration of haloperidol was suspended, and the patient was placed on Amantadine and propranolol. A mantadine was used to increase the availability of dopamine to the mid-brai n region, and the propranolol was used to control the fever, which was beli eved to be central in origin. The patient was able to complete his rehabili tation with no further incidence of fever or agitation. The patient met or exceeded all short-term physical therapy goals and was able to complete mos t of the neuropsychological tasks presented. The patient returned home 38 d ays after admission to the rehabilitation hospital and was able to perform most activities of daily Living. At the 6-months follow-up visit, the patie nt was considering entrance into an adult vocational school.