Abstract
We report a case of a 9-year-old boy who presented with altered mental status and
ataxia following 3 days of vomiting. Shortly after arrival to our emergency department,
he declined and required intubation. The following day, he recovered and was successfully
extubated. He was found to be positive for methadone on his urine drug screen. Brain
imaging demonstrated a pattern of acute cerebellitis. Following extubation, the patient
returned to his normal mental status; however, he began to have consistently elevated
blood pressure and bradycardia and subsequent brain imaging showed supratentorial
changes that were related to atypical posterior reversible encephalopathy syndrome.
Through medical management including high-dose steroids and antihypertensive medications,
the patient's blood pressure normalized, and he was eventually discharged home without
further complications.
Keywords
methadone - cerebellitis - posterior reversible encephalopathy syndrome