Acute Cytotoxic Cerebellar Edema Subsequent to Fentanyl Patch Intoxication in an Infant

Haut, Lindsey; Radhakrishnan, Rupa; Lutfi, Riad; Kao, Louise; Ackerman, Laurie L.

doi:10.1155/2021/9449565

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…It could potentially represent a more severe spectrum of OAS with a similar underlying mechanism [ 8 ]. Opioid-associated cerebellar edema has also been reported in the pediatric population after general anesthesia and use of fentanyl patch, known as pediatric opioid use-associated neurotoxicity with cerebellar edema (POUNCE) syndrome [ 9 , 10 ]. Also notably, cerebellar involvement is also seen in heroin-induced leukoencephalopathy, another opiate overdose-related encephalopathy, though heroin is a different class of opiate, and the route administration in this disease entity is through inhalation.…”

Section: Discussionmentioning

confidence: 99%

Hippocampal and Cerebellar Involvement in Opioid-Associated Amnestic Syndrome: A Unique Case Report

McConnell,

Bai

2023

Cureus

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We present a case of opioid-associated amnestic syndrome (OAS) in a 46-year-old female with persistent acute anterograde amnesia and biochemically confirmed with fentanyl use. The brain Magnetic Resonance Imaging (MRI) examination demonstrated symmetric restricted diffusion and T2/fluid-attenuated inversion recovery (FLAIR) hyperintensities in the hippocampi and cerebellum. While cases of cerebellar findings in OAS are rare in the literature, this is a unique case with corresponding images that demonstrate cerebellar involvement in addition to the more common hippocampal finding.

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Section: Discussionmentioning

confidence: 99%

Hippocampal and Cerebellar Involvement in Opioid-Associated Amnestic Syndrome: A Unique Case Report

McConnell,

Bai

2023

Cureus

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“…This condition is characterized by a diverse range of neurobehavioral symptoms, including altered mental status, psychomotor changes, seizures, and even coma, typically with spared language capabilities. While these symptoms may not readily indicate an underlying cause, they have become a subject of growing interest and concern within the medical community due to their association with opioid use [ [11] , [12] , [13] ]. Opioid-induced toxic leukoencephalopathy is relevant as it falls within the spectrum of potential neurological complications associated with opioid medications.…”

Section: Introductionmentioning

confidence: 99%

Severe cerebral edema related to oral methadone: A case report and literature review

Cañas,

Posso-Osorio,

Rivera-Londoño

et al. 2024

Heliyon

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Opioid neurotoxicity: A case series and review from members of the Child Neurology Society Neurocritical Care Special Interest Group

Boerwinkle,

Sweatt,

Grzezulkowska

et al. 2024

Annals of the Child Neurology Society

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ObjectiveThe Child Neurology Society 2023 Annual Meeting Neurocritical Care Special Interest Group discussed pediatric opioid use–associated neurotoxicity with cerebellar edema (POUNCE). Inspired by the discussion and the suspicion of an underrecognized severe form of the disorder, we provide a case series and literature review on this important and emerging topic.MethodsThe meeting was moderated by coauthor DSM, with formal presentation by coauthor AG, and supplemented with a supporting case by coauthor VLB. The attendees, by show of hand, were queried for experience with direct care of children in the critical care unit with neurotoxicity from opioid exposure. These meeting elements informed our literature review and case series.ResultsA key focus of the meeting was the importance of interdisciplinary communication regarding POUNCE, emphasizing the necessity for neurosurgical assessment due to mass effect. Approximately 10 of 40 attendees, representing different US hospitals, reported caring for children with opioid neurotoxicity and concern for increased intracranial pressure. Described during the meeting was a 2‐year‐old girl with opioid exposure, rapidly worsening neurological exam, and transforaminal herniation concerning for severe POUNCE syndrome and impact on brain networks by resting‐state functional magnetic resonanance imaging (rs‐MRI). After surgical decompression did not improve her neurological function, she underwent rs‐MRI, electroencephalogram, and MRI. The networks indicated better neurological function than the exam, consistent with outcome. In contrast, the second patient, was an 11‐month‐old boy with fentanyl exposure who was treated for opioid overdose and closely monitored clinically. He did not require surgical intervention and has recovered well.InterpretationThese patients add to the few publications documenting the management of POUNCE, which may require urgent posterior cranial fossa decompression, and highlight the potential for good outcomes. Additionally, this is the first report documenting rs‐fMRI for this condition, which was consistent with the patient's outcome.

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Acute Cytotoxic Cerebellar Edema Subsequent to Fentanyl Patch Intoxication in an Infant

Cited by 5 publications

References 19 publications

Hippocampal and Cerebellar Involvement in Opioid-Associated Amnestic Syndrome: A Unique Case Report

Hippocampal and Cerebellar Involvement in Opioid-Associated Amnestic Syndrome: A Unique Case Report

Severe cerebral edema related to oral methadone: A case report and literature review

Opioid neurotoxicity: A case series and review from members of the Child Neurology Society Neurocritical Care Special Interest Group

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