Which of the following best characterizes neuroleptic malignant syndrome?

• A. Nausea, vomiting, and diarrhea
• B. Hypothermia, hypotension, bradycardia
• C. Rash, pruritus, edema
• D. Fever, muscle rigidity, altered mental status, sweating, hypertension, and tachycardia

Answer: (D)

Neuroleptic malignant syndrome is a dangerous reaction to antipsychotic (dopamine-blocking) medications. The defining presentation is a hypermetabolic state with high fever, severe generalized muscle rigidity (often described as lead-pipe rigidity), and altered mental status, accompanied by signs of autonomic instability such as sweating, high blood pressure, and a fast heart rate. This combination reflects extensive muscle activity and central nervous system dysregulation from dopamine blockade. The other options don’t fit because they show symptoms not typical of NMS—gastrointestinal symptoms, hypothermia with bradycardia, or a rash. This option captures the full set of hallmark features needed to recognize NMS.