structural:scholar_edition
Signs and symptoms

The first symptoms of neuroleptic malignant syndrome are usually muscle cramps and tremors, fever, symptoms of autonomic nervous system instability such as unstable blood pressure, and sudden changes in mental status (agitation, delirium, or coma). Other possible symptoms include sweating, trouble swallowing, tremors, incontinence, and mutism. Once symptoms appear, they may progress rapidly and reach peak intensity in as little as three days. These symptoms can last anywhere from eight hours to forty days, with the median duration of symptoms, with treatment, being nine days. The median onset of symptoms is four days after initiating the offending medication, but in some cases symptoms may begin up to 30 days later.