Neuroleptic malignant syndrome (NMS) has been reported to occur after the initiation, modification or withdrawal of medications such as psychomimetic and antiparkinsonian drugs. We herein report a case of NMS induced by an increase in the dose of a medication. The patient survived after receiving intensive medical treatments. A 54 year-old female had been treated with a psychomimetic for three years. She acutely presented with hyperthermia and disturbance of consciousness one week after an increase in dose. She was managed with artificial ventilation, continuous hemodiafiltration, and the administration of dantrolene. Her maximum serum CPK level was 42, 550IU/l. She was weaned from the ventilator 10 days later and subsequently recovered from renal failure after 28 days. Fifty-seven days after hospitalization, she was in stable condition and was transferred to the psychiatry department. NMS is an uncommon but serious and potentially lethal drug reaction that should be diagnosed by not only psychiatry but also emergency medical professionals. History of psychiatry medications, physical examination, and blood tests may be obtained to identify potential cases of NMS. Early intensive care such as ventilation and hemodialysis are required if NMS is suspected.

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A 41-year-old man was admitted to our hospital because of penetrating medulla oblongata injury and heart injury caused by sewing needles. The patient attempted suicide by piercing the back of his neck and the left side of his chest with three needles each measuring about 3cm in length. His vital sign was stable depened on closed drainage of thoracic cavity for pneumothorax. Neurological examination showed no abnormal findings. Computed tomography of the head and the chest showed that the tip of one needle reached the back of the medulla oblongata and the other needles existed in the thoracic wall and the cardiac ventricle. Cerebral angiograms did not show any abnormal findings. Emergency surgery was performed under Xray fluoroscopy. These needles were removed after cautious exploration of the wound by first prone position and then lateral position, because of the possibility of medulla oblongata injury. The postoperative course was uneventful penetrating medulla oblongata injury is very rare. Here, we discuss the findings in the present case along with previous reports and management of penetrating brain injury.

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An automated external defibrillator (AED) is globally well-known to be a useful equipment for cardiopulmonary resuscitation (CPR), and it plays a major role in “chain of survival”. We believe that AED might also be very useful for revealing the cause of cardiac arrest. A 19-year-old healthy male collapsed during a rock concert. He was resuscitated by the doctor in a temporary clinic provided for the concert. An AED showed that shock was not required during CPR. When the ambulance arrived at the scene (seventeen minutes after the patient collapsed), the patient showed return of spontaneous circulation but he was found to be deeply comatose. On his arrival to our hospital, he was agitated and in an extremely confused state. However, his circulation had stabilized with normal sinus rhythm. Thirty-six hours after hospitalization, he woke up with a slight impairment of short-term memory. The electrocardiogram stored in the AED revealed complete heart block, which was suspected to be the cause for his cardiac arrest. Although some reports indicated that majority of the cases of sudden cardiac arrest in healthy young men were caused by ventricular fibrillation, the main cause often remains unclear. We conclude that AED is a useful equipment not only for detecting ventricular fibrillation but also for detecting the cause of cardiac arrest.

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