Acute cerebellitis following Opiate skin absorption in children and review in literature

Introduction: A one year and ten month old boy mas referred to ED with Fever and altered mental status. The patient was exposed to boiled water and was inflicted withsecond degree burn wounds from ۳ days before admission. He was also exposed to inhaled and topical usage of opium in burning sites of the body. He was transferred toPICU; because of altered mental status, seizure, bradypnea, and pinpoint pupil; after o۲ therapy, other initial treatment includes naloxan drip and levetiracetam. In laboratoryevaluation we found mixed acidosis and transaminitis; also in toxicoloy screening there was opiate positive result. Because of decrease in saturation he was intubated and because of width distribution in burning surface then we begin to start antibiotic treatment. In other investigation there was some symmetric hypodensity in cerebellum at spiral brain CT scan. At follow up MRI there was T۲ and FLAIR hypersignal in cerebellar hemisphere with mild edema and no hydrocephaly, but MRV was normal. In The ۱۰ day's hospitalization there was a good recovery in mental status, fever and seizure attack. After ۳ months he was completely normal. Method: Case report and review in literature. Conclusion and literature Review: Based on the latest evidence, the term "acute toxic leukoencephalopathy (ATL)" has been coined which is a clinicoradiologic diagnosis. ATL is characterized by cerebral and cerebellar white matter injury on diffusion weighted imaging from toxic substance. In recent studies, opiates were the second common etiology for ALT after chemotherapy medications. Until ۲۰۱۷, ۱۰ cases of toxic leukoencephalopathy following opiate consumption in children were reported which is unclear why their number is increasing. One important thing to note is that all the cases were in toddlerhood, there was no sexual Orientation, and the prognosis was good fter conservative management as with our case in which after ۳ months of conservative therapy the patient was completely normal. In severe hypoxic-ischemic ncephalopathy the cerebellum is often then the last structure affected, thus the pattern of brain involvement is different from HIE than our case. It may be because of difference between the distribution and predominance of opiate receptors in children. In contrast to many world regions, in our country opium toxicity is very common within the pediatric population. Such a high prevalence could be associated with regional geopolitical conditions, cultural context , and recently the prevalent storage of methadone syrup in households which is easily within the reach of children. Results: In any child with history of opium toxicity if we have no response to medical treatment it is better to do brain MRI to rule out of cerebellitis.