Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children
We present two recent cases of toddlers who developed malignant cerebellar edema subsequent to accidental ingestion of prescription opioids. Both children presented acute neurological decline, hydrocephalus, and tonsillar herniation requiring emergent ventricular drain placement, suboccipital cranie...
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doaj-fb9c820a0f6c4fa7b87b8f53ede3418d2020-11-25T01:09:21ZengFrontiers Media S.A.Frontiers in Neurology1664-22952017-07-01810.3389/fneur.2017.00362282759Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in ChildrenDaniel Duran0Robert D. Messina1Lauren A. Beslow2Lauren A. Beslow3Julio D. Montejo4Julio D. Montejo5Jason K. Karimy6Charuta Gavankar Furey7Charuta Gavankar Furey8Alison D. Sheridan9Gordon Sze10Yanki Yarman11Michael L. DiLuna12Michael L. DiLuna13Kristopher T. Kahle14Kristopher T. Kahle15Kristopher T. Kahle16Department of Neurosurgery, Yale School of Medicine, New Haven, CT, United StatesDepartment of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United StatesDivision of Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, United StatesDepartment of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, United StatesDepartment of Neurosurgery, Yale School of Medicine, New Haven, CT, United StatesYale School of Medicine, New Haven, CT, United StatesDepartment of Neurosurgery, Yale School of Medicine, New Haven, CT, United StatesDepartment of Neurosurgery, Yale School of Medicine, New Haven, CT, United StatesYale School of Medicine, New Haven, CT, United StatesDepartment of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United StatesDepartment of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, United StatesDepartment of Neurosurgery, Yale School of Medicine, New Haven, CT, United StatesDepartment of Neurosurgery, Yale School of Medicine, New Haven, CT, United StatesDepartment of Pediatrics, Yale School of Medicine, New Haven, CT, United StatesDepartment of Neurosurgery, Yale School of Medicine, New Haven, CT, United StatesDepartment of Pediatrics, Yale School of Medicine, New Haven, CT, United StatesDepartment of Cellular and Molecular Physiology, Yale School of Medicine, New Haven, CT, United StatesWe present two recent cases of toddlers who developed malignant cerebellar edema subsequent to accidental ingestion of prescription opioids. Both children presented acute neurological decline, hydrocephalus, and tonsillar herniation requiring emergent ventricular drain placement, suboccipital craniectomy, and partial cerebellectomy. Together with several other reports, these cases suggest the existence of an uncommon yet severe syndrome of acute opioid-induced malignant cerebellar edema. We hypothesize that the condition results from a combination of primary opioid receptor-mediated changes in neuronal metabolism that are exacerbated by secondary hypoxic insult. If recognized promptly, this syndrome can be treated with emergent neurosurgical intervention with good clinical outcomes. These cases also illustrate the unintended consequences and innocent victims of the spiraling prescription opioid epidemic, which will likely increase in prevalence. Recognition of this syndrome by clinicians is thus critical.http://journal.frontiersin.org/article/10.3389/fneur.2017.00362/fullcerebellar edemaopioid intoxicationpediatric critical careopiatessuboccipital craniectomy |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Daniel Duran Robert D. Messina Lauren A. Beslow Lauren A. Beslow Julio D. Montejo Julio D. Montejo Jason K. Karimy Charuta Gavankar Furey Charuta Gavankar Furey Alison D. Sheridan Gordon Sze Yanki Yarman Michael L. DiLuna Michael L. DiLuna Kristopher T. Kahle Kristopher T. Kahle Kristopher T. Kahle |
spellingShingle |
Daniel Duran Robert D. Messina Lauren A. Beslow Lauren A. Beslow Julio D. Montejo Julio D. Montejo Jason K. Karimy Charuta Gavankar Furey Charuta Gavankar Furey Alison D. Sheridan Gordon Sze Yanki Yarman Michael L. DiLuna Michael L. DiLuna Kristopher T. Kahle Kristopher T. Kahle Kristopher T. Kahle Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children Frontiers in Neurology cerebellar edema opioid intoxication pediatric critical care opiates suboccipital craniectomy |
author_facet |
Daniel Duran Robert D. Messina Lauren A. Beslow Lauren A. Beslow Julio D. Montejo Julio D. Montejo Jason K. Karimy Charuta Gavankar Furey Charuta Gavankar Furey Alison D. Sheridan Gordon Sze Yanki Yarman Michael L. DiLuna Michael L. DiLuna Kristopher T. Kahle Kristopher T. Kahle Kristopher T. Kahle |
author_sort |
Daniel Duran |
title |
Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children |
title_short |
Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children |
title_full |
Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children |
title_fullStr |
Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children |
title_full_unstemmed |
Malignant Cerebellar Edema Subsequent to Accidental Prescription Opioid Intoxication in Children |
title_sort |
malignant cerebellar edema subsequent to accidental prescription opioid intoxication in children |
publisher |
Frontiers Media S.A. |
series |
Frontiers in Neurology |
issn |
1664-2295 |
publishDate |
2017-07-01 |
description |
We present two recent cases of toddlers who developed malignant cerebellar edema subsequent to accidental ingestion of prescription opioids. Both children presented acute neurological decline, hydrocephalus, and tonsillar herniation requiring emergent ventricular drain placement, suboccipital craniectomy, and partial cerebellectomy. Together with several other reports, these cases suggest the existence of an uncommon yet severe syndrome of acute opioid-induced malignant cerebellar edema. We hypothesize that the condition results from a combination of primary opioid receptor-mediated changes in neuronal metabolism that are exacerbated by secondary hypoxic insult. If recognized promptly, this syndrome can be treated with emergent neurosurgical intervention with good clinical outcomes. These cases also illustrate the unintended consequences and innocent victims of the spiraling prescription opioid epidemic, which will likely increase in prevalence. Recognition of this syndrome by clinicians is thus critical. |
topic |
cerebellar edema opioid intoxication pediatric critical care opiates suboccipital craniectomy |
url |
http://journal.frontiersin.org/article/10.3389/fneur.2017.00362/full |
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