This case report describes a 2-year-old girl who presented to the emergency department with lethargy and possible seizure activity after opioid overdose. Initial CT scan showed symmetric low attenuation in the white matter of the cerebrum and cerebellar hemispheres. A urine toxicology screen was positive for opiates. Naloxone was administered but was ineffective. The report highlights the neurosurgeon's role in diagnosing and treating children with opiate-induced acute cerebellitis, which may require interventions like ventriculostomy or suboccipital decompressive craniectomy. Prompt diagnosis and treatment are important for successful outcomes in pediatric opioid overdose cases.