INTRODUCTIONOver-the-counter (OTC) drugs have sometimes been used for suicide attempt and it was reported that among OTC drugs used in adults the most common was acetaminophen in emergency hospitals in Canada [1]. Other OTC analgesics in their cases included acetylsalicylates, ibuprofen and others, and deaths were observed in case of acetaminophen and acetylsalicylate intoxications [1]. Respiratory insufficiency could occur in acetylsalicylate intoxications by way of central nervous system involvements, metabolic disorders or vomiting-induced suffocation [1]. Severe respiratory insufficiency will cause miscellaneous neurological manifestations because of secondary hypoxic-ischemic encephalopathy (HIE). In these cases the cerebellum is one of the vulnerable sites [2, 3]. However, exclusive severe cerebellar atrophy associated with remarkable cerebellar symptoms after respiratory insufficiency has not been reported probably because patients with HIE usually show extensive brain lesions as a whole.We experienced a patient who exhibited exclusively marked cerebellar dysfunction and atrophy on magnetic resonance imaging three years after salicylate poisoning and respiratory insufficiency. Cerebellar atrophy was considered to be induced in these unique clinical situations, although its definite pathophysiology remained unknown.