Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in the setting of opioid and phencyclidine use

Atac, Muhammed F.; Vilanilam, George K.; Damalcheruvu, Prashanth Reddy; Pandey, Ishan; Vattoth, Surjith

doi:10.1016/j.radcr.2023.07.015

Cited by 4 publications

(3 citation statements)

References 18 publications

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“…POUNCE syndrome is not associated with involvement of the hippocampi and basal ganglia, unlike CHANTER syndrome (as seen in our case). POUNCE syndrome is characterized by its predilection for white matter with areas of hypoattenuation on CT, and T2 hyperintense lesions on MRI [ 1 ]. Similar cases of accidental pediatric overdoses with subsequent cerebral edema have also shown a pattern of leukoencephalopathy rather than hippocampal and basal ganglia injury [ 6 , 7 ].…”

Section: Discussionmentioning

confidence: 99%

“…Clinically, patients present with altered mental status in the context of substance intoxication. The recently described pattern of imaging findings includes cytotoxic edema in bilateral hippocampi, cerebellar cortices, and the basal ganglia [ 1 ]. Patients also frequently develop early obstructive hydrocephalus from fourth ventricular compression [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

“…Patients also frequently develop early obstructive hydrocephalus from fourth ventricular compression [ 2 ]. Although these findings are usually associated with irreversible neuronal death and poor overall outcomes, patients with CHANTER syndrome can show significant clinical and radiographic improvement over time [ 1 ]. The disease has almost exclusively been observed and reported in adults, but we present the case of a 2-year-old girl who was found unconscious after consuming fentanyl.…”

Section: Introductionmentioning

confidence: 99%

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Case of pediatric cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in a 2-year-old girl

Koenigsberg,

Ross,

Timmerman

et al. 2024

Pediatr Radiol

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Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome is a recently described entity that refers to a specific pattern of cerebellar edema with restricted diffusion and crowding of the fourth ventricle among other findings. The syndrome is commonly associated with toxic opioid exposure. While most commonly seen in adults, we present a case of a 2-year-old girl who survived characteristic history and imaging findings of CHANTER syndrome.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Case of pediatric cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in a 2-year-old girl

Koenigsberg,

Ross,

Timmerman

et al. 2024

Pediatr Radiol

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CHANTER syndrome: an under-recognized cause of reversible hydrocephalus after opioid overdose

Sotiropoulos,

Harrison,

Zusman

et al. 2024

Neurol Sci

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CHANTER syndrome in the context of pain medication: a case report

Jansen,

Wulff,

Conty

et al. 2024

BMC Neurol

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Background CHANTER (Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion) is a recently described syndrome occurring in the context of drug abuse. While clinical findings are rather unspecific (disorientation, unresponsiveness), MR imaging (MRI) discloses a characteristic pattern (restricted diffusion in the basal ganglia and hippocampi, cerebellar oedema and haemorrhage), allowing for timely diagnosis before complications such as cerebellar swelling and herniation do occur. Here we report a case of CHANTER primarily based on imaging findings, as there was no evidence of drug abuse on admission. Case presentation A 62-year-old Patient was admitted to our hospital after being unresponsive at home. Prehospital intubation was performed, which limited neurological assessment. Under these circumstances no obvious symptoms could be determined, i.e. pupils were isocoric and responsive, and there were no signs of seizures. While the initial CT scan was unremarkable, the subsequent MRI scan showed a distinct imaging pattern: moderately enhancing areas in the basal ganglia and hippocampi with diffusion restriction, accompanied by cerebellar haemorrhage and oedema (Figs. 1 and 2). A comprehensive clinical and laboratory work-up was performed, including drug screening, spinal tap, Holter ECG, echocardiography and EEG. The only conspicuous anamnestic finding was a chronic pain syndrome whose medication had been supplemented with opioids two months previously. The opioid medication was discontinued, which led to a rapid improvement in the patient’s clinical condition without any further measures. The patient was able to leave the intensive care unit and was discharged 10 days after admission without persistent neurological deficits. Conclusion Familiarity with typical MRI patterns of toxic encephalopathy in patients from high-risk groups, such as drug abusers, is crucial in emergency neuroradiology. In the presence of typical MRI findings, CHANTER syndrome should be included in the differential diagnosis, even if there is no history of drug abuse, to avoid delay in diagnosis and treatment.

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Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in the setting of opioid and phencyclidine use

Cited by 4 publications

References 18 publications

Case of pediatric cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in a 2-year-old girl

Case of pediatric cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome in a 2-year-old girl

CHANTER syndrome: an under-recognized cause of reversible hydrocephalus after opioid overdose

CHANTER syndrome in the context of pain medication: a case report

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