Neuroimaging Findings in CHANTER Syndrome: A Case Series

Area of Science:

• Neurology
• Radiology
• Toxicology

Background:

• A distinct clinicoradiologic entity, CHANTER, has been identified, characterized by transient edema and restricted diffusion in the cerebellum, hippocampus, and basal nuclei.
• This condition primarily affects patients presenting in an unresponsive state after exposure to drugs of abuse, with limited existing literature.

Purpose of the Study:

• To describe the clinical and radiographic findings of three patients diagnosed with CHANTER at our institution.
• To highlight the importance of recognizing CHANTER in the differential diagnosis of unresponsive patients with specific MRI findings after opioid use.

Main Methods:

• Retrospective review of three patients with similar clinical presentations and MRI findings.
• Analysis of clinicoradiologic data, focusing on imaging characteristics and patient outcomes.

Main Results:

• The study identified three patients exhibiting the characteristic MRI findings of CHANTER.
• Unlike other causes of multifocal restricted diffusion, CHANTER is associated with obstructive hydrocephalus that is treatable.
• Treatment of hydrocephalus in these patients led to substantial clinical recovery.

Conclusions:

• CHANTER is a novel syndrome that should be considered in unresponsive patients with recent opioid use and characteristic MRI findings.
• Early recognition and management of associated hydrocephalus are crucial for favorable patient outcomes.
• Further research is warranted to fully understand the pathophysiology and long-term implications of CHANTER.