Co-occurrence of Neuroleptic Malignant Syndrome and Silent Syndrome in a Patient With Bipolar Disorder: Clinical Challenges and Long-term Neurological Sequelae.

A 31-year-old male with bipolar disorder on long-term lithium therapy presented to our emergency department with cerebellar and extrapyramidal signs, accompanied by fever and elevated creatine kinase levels. Cerebellar symptoms persisted for one year during follow-up. The patient was diag- nosed with Syndrome of Irreversible Lithium-Effectuated Neurotoxicity (SILENT) and concomitant neuroleptic malignant syndrome (NMS). This case highlights the rare coexistence of these serious complications, underscores the diagnostic and therapeutic challenges, and contributes to the litera- ture on clinical management.