Acute Cerebellitis and Atypical Posterior Reversible Encephalopathy Syndrome Associated with Methadone Intoxication.

Area of Science:

• Pediatric Neurology
• Toxicology
• Neuroimaging

Background:

• Altered mental status and ataxia in children can indicate serious neurological conditions.
• Urine drug screens are crucial for identifying potential toxic exposures.
• Acute cerebellitis and posterior reversible encephalopathy syndrome (PRES) are distinct neurological emergencies.

Observation:

• A 9-year-old boy presented with vomiting, altered mental status, and ataxia.
• He required intubation due to rapid decline but improved and was extubated the next day.
• A urine drug screen was positive for methadone.

Findings:

• Initial brain imaging revealed acute cerebellitis.
• Following extubation, the patient developed hypertension and bradycardia, with subsequent imaging showing changes consistent with atypical PRES.
• Treatment with high-dose steroids and antihypertensives resolved the hypertension and neurological symptoms.

Implications:

• This case highlights the potential for methadone to trigger both acute cerebellitis and atypical PRES in pediatric patients.
• Early recognition and aggressive management of PRES symptoms are vital for favorable outcomes.
• This case underscores the importance of considering toxicological etiologies in pediatric neurological emergencies.