J Emerg Med. 2025 Oct 24;80:51-53. doi: 10.1016/j.jemermed.2025.10.021. Online ahead of print.
ABSTRACT
BACKGROUND: Pediatric Opioid Use-Associated Neurotoxicity with Cerebellar Edema (POUNCE) is a life-threatening phenomenon in children after opioid exposure. Although symptoms of POUNCE include manifestations of the opioid exposure itself, secondary effects may be more malignant than typical opioid toxicity. Prompt recognition and treatment of POUNCE can result in favorable outcomes.
CASE REPORT: This case is a retrospective single-patient chart review in which a 2-year-old boy suffered from opioid toxicity after ingesting an unknown amount of his parent’s methadone. Upon arriving in the Emergency Department, the patient received two doses of intravenous naloxone and subsequently was placed on a continuous infusion. Presence of methadone was confirmed in both serum and urine laboratory tests. Brain magnetic resonance imaging showed extensive cerebellar edema and tonsillar herniation. The patient was taken for emergent decompression and subsequently discharged on hospital day 11 approaching neurological baseline. Why Should an Emergency Physician Be Aware of This? POUNCE is likely an underrecognized phenomenon. Prompt recognition of this disease process may decrease morbidity and mortality, as exemplified by this patient case.
PMID:41270319 | DOI:10.1016/j.jemermed.2025.10.021
