July 28, 2026

@michaelokun

One of the practical pearls I took away from Susan Fox's excellent Aspen Course lecture this morning was how important it is to quickly distinguish neuroleptic malignant syndrome (NMS), serotonin syndrome, and malignant hyperthermia, because although they can all present with fever, autonomic instability, and altered mental status, the triggers and examination findings are different. NMS should come to mind after dopamine blockade or abrupt withdrawal of dopaminergic therapy and is characterized by lead-pipe rigidity and a slower evolution. Serotonin syndrome, in contrast, is usually linked to serotonergic medications and stands out because of hyper-reflexia, clonus, and myoclonus, often developing rapidly after a medication change or overdose. Malignant hyperthermia is a different entity altogether, typically occurring after exposure to volatile anesthetics or succinylcholine in genetically susceptible individuals and requiring immediate recognition and treatment. My biggest takeaway was that the medication history, timing of symptom onset, and a careful neurological examination remain our most powerful diagnostic tools when every minute counts.