In this emergency medicine toxicology blog, Gregory Yates reflects on a recent EMCRIT podcast episode discussing serotonin syndrome, neuroleptic malignant syndrome, and other hyperthermic drug reactions. The post highlights the diagnostic importance, but potential unreliability, of neuromuscular findings such as clonus, tremor, and hyperreflexia. It also critiques the limitations of relying solely on drug history. The piece underlines the risks of misdiagnosis — and the potential danger of using antipsychotics in the wrong toxidrome. The takeaway: neurological examination can be unrelaible, and clinicians should be cautious when interpreting overlapping toxidromes.