Bilateral cerebellar hemorrhagic infarcts as an early presentation following opioid-induced toxic encephalopathy in an adult patient

Umer Ahmed; Robert Wilson; Sheng-Che Hung

doi:10.1016/j.radcr.2021.02.073

Bilateral cerebellar hemorrhagic infarcts as an early presentation following opioid-induced toxic encephalopathy in an adult patient

Radiol Case Rep. 2021 Mar 20;16(5):1207-1210. doi: 10.1016/j.radcr.2021.02.073. eCollection 2021 May.

Authors

Umer Ahmed¹, Robert Wilson², Sheng-Che Hung^{2

3}

Affiliations

¹ University of North Carolina School of Medicine, Chapel Hill, NC, USA.
² Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, Chapel Hill, NC, USA.
³ Biomedical Research Imaging Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

In the midst of the national opioid crisis, it is necessary for emergency physicians and radiologists to be familiar with presentations of opioid-related complications. We describe a case report of a 51-year-old female who developed bilateral cerebellar hemorrhages following opioid and benzodiazepine overdose. Malignant cerebellar edema is a rare but recognized complication following opiate overdose in children or chronic heroin toxicity. However, acute cerebellar involvement is rarely reported in adults. We feel that clinicians and radiologists should keep in mind the possibility of opioid toxic encephalopathy in their differential for adults with acute bilateral cerebellar infarcts and/or hemorrhages.

Keywords: Cerebellum; DWI, diffusion-weighted imaging; FLAIR, fluid-attenuated inversion recovery; Hippocampus; Leukoencephalopathy; MRI; MRI, magnetic resonance imaging; Opioid overdose; Opioid toxicity; SWI, susceptibility-weighted imaging.

Publication types

Case Reports