PMC5524743_01
Imaging studies depicting cerebellar edema and restricted water diffusion after accidental opioid overdose in two infants. Panel (A), case 1; panel (B), case 2. Top row: axial computed tomography (CT) images show severe, bilateral cerebellar hypoattenuation, with ventral displacement of the cerebellar vermis and compression of the fourth ventricles. Middle row: coronal CT images demonstrate bilateral cerebellar hypoattenuation and upward displacement of the tectal plate. Bottom row: coronal magnetic resonance diffusion-weighted imaging (DWI) depicts bilateral, symmetric cerebellar diffusion restriction [note: DWI images on panel (B) are postoperative].
fneur-08-00362-g001.jpg
PMC5524743_02_fneur-08-00362-g001.jpg
F1
CT was obtained (Figure 1B), which revealed acute hydrocephalus and extensive, symmetric bilateral cerebellar hemispheric hypoattenuation consistent with severe cerebellar edema that resulted in compression of the fourth ventricle and displacement of the midbrain and pons superiorly. Cervicomedullary junction compression secondary to cerebellar tonsillar herniation was also noted. MRI obtained on postoperative day 1 demonstrated cerebellar and cervicomedullary junction decompression, with extensive restricted diffusion in the remaining cerebellar parenchyma (Figure 1B). Multifocal areas of diffusion restriction were also noted bilaterally in the anterior cerebral artery-middle cerebral artery and middle cerebral artery-posterior cerebral artery watershed territories involving portions of the frontal, occipital, and temporal lobe white matter.
PMC5524743_02
Imaging studies depicting cerebellar edema and restricted water diffusion after accidental opioid overdose in two infants. Panel (A), case 1; panel (B), case 2. Top row: axial computed tomography (CT) images show severe, bilateral cerebellar hypoattenuation, with ventral displacement of the cerebellar vermis and compression of the fourth ventricles. Middle row: coronal CT images demonstrate bilateral cerebellar hypoattenuation and upward displacement of the tectal plate. Bottom row: coronal magnetic resonance diffusion-weighted imaging (DWI) depicts bilateral, symmetric cerebellar diffusion restriction [note: DWI images on panel (B) are postoperative].
fneur-08-00362-g001.jpg
PMC5524743_02_fneur-08-00362-g001.jpg
F1
CT was obtained (Figure 1B), which revealed acute hydrocephalus and extensive, symmetric bilateral cerebellar hemispheric hypoattenuation consistent with severe cerebellar edema that resulted in compression of the fourth ventricle and displacement of the midbrain and pons superiorly. Cervicomedullary junction compression secondary to cerebellar tonsillar herniation was also noted. MRI obtained on postoperative day 1 demonstrated cerebellar and cervicomedullary junction decompression, with extensive restricted diffusion in the remaining cerebellar parenchyma (Figure 1B). Multifocal areas of diffusion restriction were also noted bilaterally in the anterior cerebral artery-middle cerebral artery and middle cerebral artery-posterior cerebral artery watershed territories involving portions of the frontal, occipital, and temporal lobe white matter.