{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,16]],"date-time":"2026-05-16T15:10:56Z","timestamp":1778944256329,"version":"3.51.4"},"reference-count":14,"publisher":"BMJ","issue":"8","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2021,7,21]]},"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:p>We report the case of a middle-aged woman with a history of bipolar disorder, in the absence of alcohol or substance misuse. The patient had been maintained on fluphenazine decanoate depot and now presented acutely with cognitive dysfunction and rigidity. Laboratory tests revealed elevated creatine kinase, acute kidney injury with metabolic acidosis and transaminitis, leading to a provisional diagnosis of neuroleptic malignant syndrome (NMS). Neuroleptics were withheld; dialysis was commenced; and blood biochemistry parameters improved in tandem. However, mental status changes persisted, and re-evaluation revealed multidirectional nystagmus with bilateral past-pointing. MRI confirmed the diagnosis of Wernicke\u2019s encephalopathy (WE). Prompt recovery followed treatment with high-dose intravenous thiamine. We discuss the co-occurrence of NMS and non-alcoholic WE\u2014highlighting the need for a high index of suspicion for these relatively rare neuropsychiatric diagnoses which are often missed in those with atypical presentations.<\/jats:p>","DOI":"10.1136\/bcr-2021-244082","type":"journal-article","created":{"date-parts":[[2021,8,5]],"date-time":"2021-08-05T12:26:52Z","timestamp":1628166412000},"page":"e244082","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Atypical neuroleptic malignant syndrome and non-alcoholic Wernicke\u2019s encephalopathy"],"prefix":"10.1136","volume":"14","author":[{"given":"Esther Shan Lin","family":"Hor","sequence":"first","affiliation":[{"name":"Internal Medicine, Taiping Hospital, Taiping, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gurpreet Pal","family":"Singh","sequence":"additional","affiliation":[{"name":"Internal Medicine, Taiping Hospital, Taiping, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nurul Akhmar","family":"Omar","sequence":"additional","affiliation":[{"name":"Radiology, Taiping Hospital, Taiping, Malaysia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vincent","family":"Russell","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Royal College of Surgeons in Ireland, Dublin, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,8,5]]},"reference":[{"key":"2025082707240855000_14.8.e244082.1","unstructured":"Ruiz P , Sadock BJ , Sadock VA . Comprehensive textbook of psychiatry. Philadelphia, PA: lippincott Williams & wilkins, 2000."},{"key":"2025082707240855000_14.8.e244082.2","doi-asserted-by":"publisher","DOI":"10.4088\/JCP.10m06438"},{"key":"2025082707240855000_14.8.e244082.3","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1016\/j.genhosppsych.2019.06.009","article-title":"Atypical neuroleptic malignant syndrome: a systematic review of case reports","volume":"60","author":"Singhai","year":"2019","journal-title":"Gen Hosp Psychiatry"},{"key":"2025082707240855000_14.8.e244082.4","doi-asserted-by":"publisher","DOI":"10.1111\/j.1468-1331.2010.03153.x"},{"key":"2025082707240855000_14.8.e244082.5","first-page":"33","article-title":"Case Study: An unusual case of Wernicke\u2019s encephalopathy-Thiamin deficiency in advanced gastric adenocarcinoma","volume":"29","author":"Plaskett","year":"2016","journal-title":"South Afr J Clin Nutr"},{"key":"2025082707240855000_14.8.e244082.6","doi-asserted-by":"publisher","DOI":"10.1093\/bja\/85.1.129"},{"key":"2025082707240855000_14.8.e244082.7","first-page":"36","article-title":"Neuroleptic malignant syndrome: still a risk, but which patients may be in danger","volume":"2","author":"Caroff","year":"2003","journal-title":"Curr Psychiatry"},{"key":"2025082707240855000_14.8.e244082.8","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1192\/pb.bp.116.053736","article-title":"Drug information update. atypical antipsychotics and neuroleptic malignant syndrome: nuances and pragmatics of the association","volume":"41","author":"Sarkar","year":"2017","journal-title":"BJPsych Bull"},{"key":"2025082707240855000_14.8.e244082.9","doi-asserted-by":"publisher","DOI":"10.2174\/157488609787354387"},{"key":"2025082707240855000_14.8.e244082.10","first-page":"134","article-title":"The role of thiamine deficiency in alcoholic brain disease","volume":"27","author":"Martin","year":"2003","journal-title":"Alcohol Res Health"},{"key":"2025082707240855000_14.8.e244082.11","doi-asserted-by":"publisher","DOI":"10.1016\/0022-510X(89)90095-6"},{"key":"2025082707240855000_14.8.e244082.12","doi-asserted-by":"publisher","DOI":"10.1016\/j.psym.2012.04.008"},{"key":"2025082707240855000_14.8.e244082.13","doi-asserted-by":"crossref","DOI":"10.1093\/omcr\/omy013","article-title":"Wernicke encephalopathy: (MRI) picture worth a thousand words","volume":"2018","author":"Jan","year":"2018","journal-title":"Oxf Med Case Reports"},{"key":"2025082707240855000_14.8.e244082.14","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp.62.1.51"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2021-244082","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,8,27]],"date-time":"2025-08-27T14:24:15Z","timestamp":1756304655000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2021-244082"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8]]},"references-count":14,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2021,8,5]]},"published-print":{"date-parts":[[2021,8]]}},"alternative-id":["10.1136\/bcr-2021-244082"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2021-244082","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8]]}}}