Wijdicks, Eelco FM

Abstract Background Fever and worsening rigidity in Parkinson's disease (PD) may resemble neuroleptic malignant syndrome (NMS). We examined PD patients diagnosed with NMS—regardless of whether diagnostic criteria were used—to establish the clinical characteristics and etiology. Cases Among 15 cases, 40% (6/15) required ICU admission, 27% (4/15) required mechanical ventilation, 80% (12/15) recovered, and 20% (3/15) died. 27% (4/15) had a reduction in carbidopa‐levodopa as the primary trigger, 27% (4/15) had sepsis in addition to concurrent reductions in carbidopa‐levodopa, 7% (1/15) had sepsis alone, 33% (5/15) were exposed to new or increased antidopaminergic drugs, and 7% (1/15) had deep brain stimulator (DBS) malfunction. Literature Review Several terms to describe exacerbation of parkinsonism including NMS‐like state and parkinsonism hyperpyrexia syndrome (PHS) have been proposed over the years but may be restrictive in their definitions and confounders exist. Conclusions Acute parkinsonism dopamine depletion syndrome (APDDS) might be a more encompassing term to describe to an acute exacerbation of preexisting parkinsonism resulting from recent reduction in dopaminergic or other Parkinson's therapy (eg, DBS failure), or exposure to antidopaminergics. Symptoms include increased rigidity, encephalopathy, hyperthermia, or autonomic instability. Sepsis is a frequent confounder and may be associated with concurrent reduction or discontinuation of carbidopa‐levodopa.

Abstract This book comprises a collection of case studies of patients with acute and critical neurological disease, along with pertinent discussion of approaches to each particular condition. Case studies provide a way to examine how difficult it is to approach these patients situated in the neurosciences intensive care unit. Some patients need close observation and management of emerging problems, others need a neurosurgical intervention or a neurointerventional procedure, a few patients are in extremis. The examples provided in this book are quintessential to the practice of neurocritical care. Some are less common conditions that need to be recognized and appropriately treated. Another purpose of this book is to introduce the reader to the field of neurocritical care and to show what goes on. The book shows the complexity of care and urgent decision-making involved in treating patients who deteriorate. Practical suggestions are included for each topic it covers. Not only is treatment of serious neurological disorders discussed but also prognostication in practice and end-of-life care discussions. In some ways this book summarizes the entire spectrum of presenting acute illness and how best to intervene.