Which condition is characterized by autonomic dysfunction, hyperthermia, altered consciousness, and muscle rigidity?

• A. Extrapyramidal symptoms
• B. Neuroleptic malignant syndrome
• C. Serotonin syndrome
• D. Malignant hyperthermia

Answer: (B)

Neuroleptic malignant syndrome is a life‑threatening reaction to dopamine D2 receptor blockade from antipsychotic drugs. It typically presents with severe hyperthermia, prominent muscular rigidity (often lead-pipe), and autonomic instability such as fluctuating blood pressure and tachycardia, accompanied by altered mental status. This combo arises because abrupt dopamine suppression in the brain’s motor and autonomic control centers leads to heat production from sustained muscle contraction and dysregulated autonomic responses. The described pattern—high fever, autonomic changes, altered consciousness, and marked rigidity after exposure to a dopamine-blocking agent—fits this syndrome best. Extrapyramidal symptoms can include rigidity but usually lack the profound fever and autonomic instability. Serotonin syndrome also has high fever and mental status changes but features hyperreflexia and clonus rather than the classic lead-pipe rigidity. Malignant hyperthermia occurs in the perioperative setting with anesthesia exposure, not from antipsychotic use, and thus doesn’t fit the typical context here.