Wednesday, September 9, 2009


A 20 year old man is brought in by police with agitation and combativeness. On exam, he is tachycardic, hypertensive, and hyperthermic. In general, he is a diaphoretic, flushed man. Neuro exam shows vertical nystagmus even while the patient is awake as well as hyperreflexia. HEENT exam shows miosis and hypersalivation. Psych exam reveals he has acute new-onset schizophrenia, psychosis, audio-visual hallucinations, and paranoid delusions.

Challenge: You avoid the complication of rhabdomyolysis because you recognize this diagnosis as...what?

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Alex said...

neuroleptic malignant syndrome?

Craig Chen said...

interesting thought, i like it, NMS presents with mental status change, hyperthermia, and ANS instability, but also muscle rigidity. I was actually getting at another diagnosis with the vertical nystagmus.

Carinii refers to the abbreviation PCP, pneumocystis jirovecii (previously carinii) pneumonia or phencyclidine, the molecule shown here. Phencyclidine is a cheap, easily manufactured synthetic hallucinogen that can be found as powder, tablet, crystal, and liquid, and can be ingested, inhaled, injected, or smoked. PCP binds NMDA receptors, dopamine, norepinephrine, and serotonin reuptake complexes, and opiate receptor complexes. The nystagmus is characteristic of PCP (but vertical nystagmus can also be seen in nicotine ingestion).

Sources: UpToDate; Wikipedia.