Key Characteristics

Onset: 1-3 days

The hallmark symptoms of NMS include (in the order of appearing)

1. Altered Mental Status: Confusion, agitation, delirium, or even coma in severe cases.
2. Severe Rigidity (Muscle Stiffness) : often described as Lead-pipe regidity
3. Autonomic Dysfunction: Symptoms like high blood pressure, rapid heart rate, sweating, and labile blood pressure.
4. Hyperthermia (Fever above 40°C).

Mimicker

• !Serotonin syndrome (UMN, <6h)
• Acute dystonic reaction

Complication

• 30% get !Rhabdomyolysis
  • Among which 30% get !AKI - Acute Kidney Injury