title: MRI findings in 6 cases of children by inadvertent ingestion of diphenoxylate-atropine.
abstract: OBJECTIVE
  Compound diphenoxylate (diphenoxylate-atropine) poisoning can cause toxic encephalopathy in children, and magnetic resonance imaging (MRI) of the brain in this condition has not been reported. This study is to analyze brain MRI findings and to investigate the relations between MRI features and possible pathophysiological changes in children.
  
  
  METHODS
  Six children accidentally swallowed compound diphenoxylate, 4 males, 2 females, aged 20-46 months, average 33 months. Quantity of ingested diphenoxylate-atropine was from 6 to 30 tablets, each tablet contains diphenoxylate 2.5mg and atropine 0.025 mg. These patients were referred to our hospital within 24h after diphenoxylate-atropine ingestion, and underwent brain MRI scan within 24-72 h after emergency treatment. The characteristics of conventional MRI were analyzed.
  
  
  RESULTS
  These pediatric patients had various symptoms of opioid intoxication and atropine toxicity. Brain MRI showed abnormal low signal intensity on T1-weighted images (T1WI) and abnormal high signal intensity on T2-weighted images (T2WI) and fluid-attenuated inversion recovery (FLAIR) imaging in bilateral in all cases; abnormal high signal intensity on T1WI, T2WI and FLAIR in 4 cases. Encephalomalacia was observed in 3 cases during follow-up.
  
  
  CONCLUSIONS
  In the early stage of compound diphenoxylate poisoning in children, multiple extensive edema-necrosis and hemorrhagic-necrosis focus were observed in basic nucleus, pallium and cerebellum, these resulted in the corresponding brain dysfunction with encephalomalacia. MRI scan in the early stage in this condition may provide evidences of brain impairment, and is beneficial for the early diagnosis, treatment and prognosis assessment.
authors.affiliation: Shandong University School of Medicine, Shandong Medical Imaging Research Institute, Jinan 250012, PR China.
authors.forename: Lianxiang
authors.initials: L
authors.lastname: Xiao
authors.forename: Xiangtao
authors.initials: X
authors.lastname: Lin
authors.forename: Jinfeng
authors.initials: J
authors.lastname: Cao
authors.forename: Xueyu
authors.initials: X
authors.lastname: Wang
authors.forename: Lebin
authors.initials: L
authors.lastname: Wu
mesh_terms: D001285:Atropine / Q000506:poisoning*; D002675:Child, Preschool; D004157:Diphenoxylate / Q000506:poisoning*; D005260:Female; D006801:Humans; D007223:Infant; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D020258:Neurotoxicity Syndromes / Q000175:diagnosis*
chemical_list: D004157:Diphenoxylate; D001285:Atropine