Q: What is Parkinsonism-hyperpyrexia syndrome?

Answer: If a patient with Parkinson disease suddenly stops or decrease the dose of levodopa or dopamine agonists, - may develop neuroleptic malignant syndrome. It may become a life threatening situation and requires ICU admission. Clinical pearl to remember is replacing antiparkinson drug at the dose that was used prior to the onset of the syndrome, via any route including IV.  Dantrolene or bromocriptine can be used if there is no response to restart of patient's previous medicines.


References:

1. Factor SA. Fatal Parkinsonism-hyperpyrexia syndrome in a Parkinson's disease patient while actively treated with deep brain stimulation. Mov Disord 2007; 22:148. 

2. Newman EJ, Grosset DG, Kennedy PG. The parkinsonism-hyperpyrexia syndrome. Neurocrit Care 2009; 10:136.