窒息による心肺停止蘇生後に悪性症候群を合併したパーキンソン病の1例(A case of neuroleptic malignant syndrome following cardiopulmonary resuscitation from asphyxia)

要旨 心停止後症候群（post cardiac arrest syndrome: PCAS）に対し，目標体温管理（targeted temperature management: TTM）を施行したのちに約半数の症例で高体温を認める。しかしながら，高体温の原因がはっきりせず，治療方針の決定に難渋することが多い。今回，PCASに対しTTM施行後に高体温を認め，その原因として悪性症候群が強く疑われた症例を経験した。症例はパーキンソン病の既往がある69歳の女性。窒息により心肺停止（cardiopulmonary arrest: CPA）となった。自己心拍が再開し，24時間のTTMを施行した。復温後に40℃台の高体温を認め，第5病日，creatine kinase（CK）上昇，筋強剛を認めた。第6病日に悪性症候群と診断し，ダントロレンを開始した。以後CKおよび錐体外路徴候は改善し，最終的に悪性症候群による臓器機能障害を残さずに改善した。CPA蘇生後に高体温を認めた症例において，悪性症候群を鑑別に挙げる必要がある。 ABSTRACT Targeted temperature management (TTM) for post cardiac arrest syndrome (PCAS) is followed by hyperthermia in about half of all of the PCAS patients. However, it is often hard to decide the treatment without understanding the cause of hyperthermia. We present a case in which TTM for PCAS was followed by hyperthermia caused by neuroleptic malignant syndrome. The patient was a 69–year–old woman with a history of Parkinson’s disease, in whom asphyxia resulted in cardiopulmonary arrest (CPA). Following the return of spontaneous circulation after cardiopulmonary resuscitation, TTM was performed for 24 hours. Rewarming was followed by hyperthermia (approximately 40˚C). On day 5 following resuscitation, neuroleptic malignant syndrome was diagnosed on the basis of elevated creatine kinase (CK) and the presence of extrapyramidal signs. On day 6, the patient was started on dantrolene, and both CK and extrapyramidal signs subsequently improved, ultimately leaving no impairment of organic function due to neuroleptic malignant syndrome. Neuroleptic malignant syndrome must be considered in patients who develop hyperthermia following CPA.