1-7) NMS is characterized by an abnormal mental status (eg, confusion, catatonia, and coma), hyperthermia, "lead-pipe" rigidity, akinesia or dystonia, autonomic instability, rhabdomyolysis, myoclonus, coarse tremors, and, occasionally, cogwheeling
She exhibited hypomimia, limb rigidity with intermittent cogwheeling
, and left arm dysmetria.
There was no abnormally high muscle tone, cogwheeling
, past-pointing, nystagmus, or fixed facies.
When it is properly managed, it is more like the cogwheeling
of Parkinson's disease with sudden advances as the resistance opposing it gives way in small increments when positive energy is applied.
The phenomenon of cogwheeling
in the upper limbs is a result of rigidity and superimposed rhythmic contractions on passive stretching of the muscles.