An early report on the role of nitrates in erectile dysfunction.

ajp.psychiatryonline.org neuroleptic malignant syndrome (1, 2). Other investigators have reported typical neuroleptic malignant syndrome features from treatment with atypical antipsychotics (4). Although our patient presented with neck stiffness, no rigidity was found, and no fever was initially noted. Additionally, he did not manifest a number of symptoms associated with neuroleptic malignant syndrome, such as altered mental status, tremor, diaphoresis, mutism, incontinence, and sialorrhea. Many patients who develop neuroleptic malignant syndrome with high creatinine phosphokinase levels develop renal failure, which is often a main cause of death. In the present case, despite extreme elevations of creatinine phosphokinase levels, renal function was preserved, although cardiac and pulmonary complications emerged. Nearly all reports of neuroleptic malignant syndrome within the past 5 years involved a creatinine phosphokinase level ≤10,000 U/l. Why do creatinine phosphokinase levels vary so markedly? Some investigators have suggested that the creatinine phosphokinase level is a prognostic indicator (3). If this is the case, our patient’s total recovery is striking.