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Muscle changes in the
neuroleptic malignant syndrome.
Behan WM, Madigan
M, Clark BJ, Goldberg J, McLellan DR.
University Department
of Pathology, Western Infirmary, Glasgow, UK.
wmb1q@clinmed.gla.ac.uk
AIMS: To characterise the skeletal muscle
changes in the neuroleptic malignant syndrome (NMS). METHODS: Detailed
light and ultrastructural examination was carried out on skeletal muscle
from three cases of NMS, two associated with recreational drugs
(3,4-methlenedioxymethylamphetamine (MDMA, Ecstasy) and lysergic acid
diethylamide (LSD)) and one with antipsychotic drugs (fluoxetine
(Prozac) and remoxipride hydrochloride monohydrate (Roxiam)). RESULTS:
The muscles were grossly swollen and oedematous in all cases, in one
with such severe local involvement that the diagnosis of sarcoma was
considered. On microscopy, there was conspicuous oedema. In some
fascicles less than 10% of fibres were affected whereas in others more
than 50% were pale and enlarged. There was a spectrum of changes: tiny
to large vacuoles replaced most of the sarcoplasm and were associated
with necrosis. A striking feature in some fibres was the presence of
contraction bands separating segments of oedematous myofibrils. Severe
endomysial oedema was also detectable. There was a scanty mononuclear
infiltrate but no evidence of regeneration. CONCLUSIONS: The muscle
changes associated with NMS are characteristic and may be helpful in
differential diagnosis.
Publication Types:
PMID: 10823143 [PubMed - indexed for
MEDLINE]
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