CHANTER syndrome in a cocaine positive patient

CHANTER syndrome is a rare pattern of neurotoxicity characterized by restricted diffusion on magnetic resonance imaging in the cerebellum, hippocampi, and basal nuclei in a severe and symmetrical pattern. Multiple case studies have explored its likely etiology being recent opioid or poly-substance use. However, few case studies have found this syndrome after recent cocaine mono-use. In this report we describe an individual admitted to the Neurosciences Intensive Care Unit who had imaging findings most consistent with CHANTER syndrome and a urine toxicology screen positive only for cocaine. The patient was treated with high-dose thiamine, folate, amantadine, modafinil and was discharged to a long term acute care facility. Possible mechanisms of injury are explored such as damage from vasospasm, vasoconstriction, impairment of dopamine and glutamate neurotransmission, oxidative stress from cocaine metabolites, and direct mitochondrial damage. This case adds to a newly established growing body of literature on CHANTER syndrome to support future diagnosticians in reviewing patients with characteristic neuroimaging findings and a recent history of cocaine use.