Toxic encephalopathy is a neurologic disorder caused by exposure to neurotoxic organic solvents such as toluene, following exposure to heavy metals such as manganese, as a side effect of melarsoprol treatment for African trypanosomiasis, adverse effects to prescription drugs, or exposure to extreme concentrations of any natural toxin such as cyanotoxins found in shellfish or freshwater cyanobacteria crusts. 
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A  51-year-old female who developed bilateral [[cerebellar hemorrhage]]s following [[opioid]] and [[benzodiazepine]] overdose. [[Malignant cerebellar edema]] is a rare but recognized complication following opiate overdose in children or chronic [[heroin]] toxicity. However, acute cerebellar involvement is rarely reported in adults. 
Ahmed et al. feel that clinicians and radiologists should keep in mind the possibility of opioid toxic [[encephalopathy]] in their differential for adults with acute bilateral cerebellar infarctions and/or hemorrhages
((Ahmed U, Wilson R, Hung SC. Bilateral [[cerebellar hemorrhagic infarct]]s as an early presentation following [[opioid]]-induced [[toxic encephalopathy]] in an adult patient. Radiol Case Rep. 2021 Mar 20;16(5):1207-1210. doi: 10.1016/j.radcr.2021.02.073. PMID: 33815643; PMCID: PMC8010571.))