Dextromethorphan-Associated Neurotoxicity with Cerebellar Edema Syndrome in Young Children: Neuroimaging Features

Area of Science:

• Pediatric Neurology
• Toxicology
• Neuroimaging

Background:

• Dextromethorphan (DXM) overdose in young children (<5 years) can lead to severe outcomes.
• Early recognition and management are critical for a positive clinical prognosis.

Purpose of the Study:

• To describe a new clinical entity, dextromethorphan-associated neurotoxicity with cerebellar edema (DANCE).
• To raise awareness of DXM toxicity in pediatric patients presenting with specific neuroimaging findings.

Main Methods:

• Case series of 3 pediatric patients (<5 years) with unresponsiveness after ingesting DXM-containing cough medicine.
• Neuroimaging (MRI) was used to evaluate brain abnormalities.

Main Results:

• All patients exhibited cytotoxic edema in cerebellar hemispheres on MRI.
• Two patients also showed diffusion-restricting foci in the supratentorial white matter.
• These findings are similar to pediatric opioid use-associated neurotoxicity with cerebellar edema (POUNCE).

Conclusions:

• Dextromethorphan-associated neurotoxicity with cerebellar edema (DANCE) is a distinct clinical and neuroimaging syndrome in young children.
• Prompt diagnosis and management of DANCE are essential for favorable outcomes in pediatric DXM toxicity.