Disclosures: Lydia G. Singerman, MD: No financial relationships or conflicts of interest

Case Diagnosis: Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER syndrome)

Case Description: Patient is a 24-year-old male who presented to acute care after being found unresponsive with suspected drug overdose. CT head showed hypoattenuation in the bilateral posterior cerebellar hemispheres and hippocampi. MRI showed abnormal signals in bilateral hippocampi, internal capsule, and posterior cerebellum. Urine drug screen was positive for cocaine and fentanyl. Patient was initially intubated for airway protection and treated with naloxone and IV fluids. He remained in acute care for 10 days; prior to transfer he was extubated and advanced to a regular diet and thin liquids.

Setting: acute inpatient rehabilitation hospital

Assessment/Results: On admission to rehab, the patient was oriented to person, hospital, and year. He was fluent with intact naming and repetition and able to follow commands. However, his deficits remained with memory and higher cognitive functioning. Over his stay he made slow but measurable progress in functional recall and higher-level cognitive goals. Data includes MOCA 8.3 completed on admission scoring 16/30; discharge ~2 weeks later scoring 22/30 (normal >/30 26/30)

Discussion: Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER syndrome) is a recently recognized syndrome. It includes both radiographic and clinical findings in adults after opioid overdose. Radiographic findings include cytotoxic edema in the bilateral hippocampi and cerebellar cortices. Clinically, patients are usually obtunded. Though these findings are usually associated with poor outcomes, with early intervention and comprehensive rehab patients with CHANTER syndrome have shown improvement both clinically and radiographically.

Conclusion: This case helps demonstrate the unique clinical course of CHANTER syndrome. Despite the initial presentation, with early intervention, patients have the potential for significant clinical improvement in cognitive functioning using modalities such as visual reminders, rehearsal, and memory cues.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/cerebellar-hippocampal-and-basal-nuclei-transient-edema-with-restricted-diffusion-chanter-syndrome/