This case report describes an opioid overdose in a 2-year-old girl who presented to the emergency department with lethargy and possible seizure activity. Initial CT scan revealed symmetric low attenuation in the white matter of the cerebrum and cerebellar hemispheres and effacement of the prepontine cistern, suggestive of opioid overdose prior to toxicology confirmation of opiates in her urine. She was resuscitated, intubated, and administered naloxone without effect. In cases of opioid-induced acute cerebellitis, neurosurgical intervention such as ventriculostomy or suboccipital decompressive craniectomy may be required for acute hydrocephalus and cerebell