Dextromethorphan-Associated Neurotoxicity with Cerebellar Edema Syndrome in Young Children: Neuroimaging Features

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2024 Aug 16

PMID 39151957

Authors

Smily Sharma

Sarbesh Tiwari

Lokesh Saini

Taruna Yadav

Sujatha Manjunathan

Ananya Panda

Bharat Choudhary

Daisy Khera

Affiliations

Soon will be listed here.

Abstract

Dextromethorphan toxicity in young children (especially those 4 years of age or younger) can have an extremely poor prognosis if untreated. However, if timely recognized and optimally managed, it can have a good clinical outcome despite a profound initial insult. We present 3 pediatric cases (younger than 5 years of age) with sudden unresponsiveness following ingestion of cough medications containing dextromethorphan. All these children showed cytotoxic edema in the cerebellar hemispheres on MR of the brain, with diffusion-restricting foci in the supratentorial white matter in 2 patients. These features resemble the recently described acute opioid toxidrome in children, pediatric opioid use-associated neurotoxicity with cerebellar edema (POUNCE). Hence, we named this entity dextromethorphan-associated neurotoxicity with cerebellar edema (DANCE) to increase the awareness of dextromethorphan toxicity in young children and the need to promptly recognize it to initiate optimal management.

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