Opioid overdose in a child: case report and discussion with emphasis on neurosurgical implications.
In environments in which opioids are increasingly abused for recreation, children are becoming more at risk for both accidental and nonaccidental intoxication. In toxic doses, opioids can cause potentially lethal acute leukoencephalopathy, which has a predilection for the cerebellum in young children. The authors present the case of a 2-year-old girl who suffered an accidental opioid overdose, presenting with altered mental status requiring cardiorespiratory support. She required emergency posterior fossa decompression, partial cerebellectomy, and CSF drainage due to cerebellar edema compressing the fourth ventricle. To the authors' knowledge, this is the first report of surgical decompression used to treat cerebellar edema associated with opioid overdose in a child.
Department of Neurosurgery, Emory University School of Medicine;|Department of Pediatrics, Emory University School of Medicine;|Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia; and.
Andrew
A
Reisner
Department of Radiology, Children's Healthcare of Atlanta, Scottish Rite Hospital;
Laura L
LL
Hayes
Department of Neurosurgery, Emory University School of Medicine;
Christopher M
CM
Holland
Department of Neurosurgery, Emory University School of Medicine;|Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia; and.
David M
DM
Wrubel
Department of Neurosurgery, Children's Hospitals and Clinics of Minnesota, St. Paul, Minnesota.
Meysam A
MA
Kebriaei
Georgia Poison Center;|Department of Pediatrics, Emory University School of Medicine;
Robert J
RJ
Geller
Department of Neurosurgery, Emory University School of Medicine;
Griffin R
GR
Baum
Department of Neurosurgery, Emory University School of Medicine;|Pediatric Neurosurgical Associates, Children's Healthcare of Atlanta, Georgia; and.
Joshua J
JJ
Chern
D000701:Analgesics, Opioid / Q000008:administration & dosage / Q000009:adverse effects*; D002531:Cerebellum / Q000187:drug effects / Q000473:pathology / Q000601:surgery*; D002557:Cerebrospinal Fluid Shunts; D002675:Child, Preschool; D003244:Consciousness Disorders / Q000139:chemically induced*; D003388:Cranial Fossa, Posterior / Q000601:surgery; D019299:Decompression, Surgical; D062787:Drug Overdose; D004487:Edema / Q000139:chemically induced; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D059906:Neuroimaging / Q000379:methods; D019635:Neurosurgical Procedures; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
D000701:Analgesics, Opioid
PICU = pediatric intensive care unit; acute leukoencephalopathy; cerebellitis; opioid toxicity; surgical treatment