Severe bilateral cerebellar edema from ingestion of ketamine: case report

Abstract

<jats:p>The use of ketamine as a drug of abuse has increased and so too has the risk of accidental overdose. Here, the authors report the case of a 10-month-old infant who inadvertently ingested ketamine. The child demonstrated severe cerebellar swelling that required emergency surgical intervention. The authors describe the clinical course of this child and present the radiographic characteristics of the brain. The imaging characteristics were not consistent with purely anoxic injury, thus suggesting a specific effect of this drug. To the authors’ knowledge, similar imaging characteristics in this context have not been described.</jats:p>

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

“…Initial imaging usually reveals cerebellar cytotoxic injury and swelling, which can be complicated by development of acute obstructive hydrocephalus and tonsillar herniation. This case as well as another from our institution caused by “Kommon” (tobacco leaves soaked in ketamine) joins a few other published cases in highlighting the existence of an uncommon yet severe syndrome of acute cerebellar cytotoxic edema in the setting of opioid or ketamine toxicity [ 10 , 11 ]. Though there are few cases reported, a 2017 case series reported that four of 10 patients required posterior fossa craniectomy and CSF diversion with resultant good functional outcomes [ 11 ].…”

“…As hydrocephalus can progress quickly in patients with limited neurologic exams, Reisner et al recommend routine serial CT scanning for the first 48 hours for more timely identification of neuroradiographic sequelae [ 7 ]. While routine neurosurgical intervention is not recommended, if hydrocephalus is present, case outcomes show the importance of timely neurosurgical intervention [ 7 , 10 , 11 , 20 ].…”