Methadone-induced Toxic Encephalopathy In Pediatric Patients: Two Case Reports

Authors

  • Siew Ching Tiong
  • Julian Sau Lian Chieng
  • Hau Wei Khoo
  • Chee Hui Ng

DOI:

https://doi.org/10.3941/jrcr.v13i5.3658

Keywords:

Methadone, encephalopathy, cerebellitis, pediatrics, magnetic resonance imaging

Abstract

Toxic encephalopathy is a wide spectrum of encephalopathy secondary to insult from toxic substances, with variable clinical presentations from minor cognitive impairment to severe neurological dysfunction and death. Methadone-induced toxic encephalopathy is an extremely rare form of toxic encephalopathy which typically demonstrates abnormal imaging findings in the dentate nuclei or cerebellum. This is a report of methadone-induced toxic encephalopathy in two toddlers secondary to accidental ingestion. They were brought in unconscious to the emergency department of a tertiary hospital and were found to be cyanotic and pulseless, requiring cardiopulmonary resuscitation and mechanical ventilation. Magnetic resonance imaging (MRI) of the brain of both patients showed similar findings of symmetrical hyperintense foci in bilateral cerebellar hemispheres on T2-weighted and fluid-attenuated inversion recovery (FLAIR) sequences. These areas also demonstrated diffusion restriction on diffusion weighted imaging (DWI). Blood and urine toxicology results confirmed the presence of methadone in both patients. As the exact substance of accidental ingestion may not be known at the time of presentation, early radiological diagnosis of methadone-induced encephalopathy may prompt early initiation of treatment to prevent further life-threatening complications, particularly in vulnerable pediatric population.

Author Biographies

Siew Ching Tiong

Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore

Julian Sau Lian Chieng

Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore

Hau Wei Khoo

Department of Diagnostic Radiology, Tan Tock Seng Hospital, Singapore

Chee Hui Ng

Department of Diagnostic and Interventional Imaging, KK Women's and Children's Hospital, Singapore

 

Published

2019-05-21

Issue

Section

Neuroradiology