Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome
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At the time the article was created Francis Deng had no recorded disclosures.View Francis Deng's current disclosures
At the time the article was last revised Rohit Sharma had no financial relationships to ineligible companies to disclose.View Rohit Sharma's current disclosures
Cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome is a recently described constellation of imaging findings in adults with opioid neurotoxicity. It is characterized by cytotoxic edema in the bilateral hippocampi and cerebellar cortices, and variably in the basal ganglia 1.
This entity likely falls within a pathophysiologic spectrum with pediatric opioid use‐associated neurotoxicity with cerebellar edema (POUNCE) syndrome (which occurs in children), and opioid-associated amnestic syndrome (which involves the hippocampi alone). It is probably distinct from chasing the dragon leukoencephalopathy, which predominantly affects white matter and occurs after inhalational heroin use.
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Patients present with a decreased level of consciousness 1,2.
Imaging shows cerebellar edema, which may progress to cause hydrocephalus 2. MRI demonstrates bilateral, symmetric restricted diffusion in the grey matter of the cerebellum and hippocampi, as well as asymmetric involvement of the basal ganglia 1,2. The cerebral cortex is spared 1.
History and etymology
The syndrome was first described by an American group of clinicians in a seminal case series in 2019 1.
- hypoxic-ischemic encephalopathy can also cause restricted diffusion in the hippocampus, cerebellar cortex, and deep grey nuclei, but cerebral cortex should also be involved
- chasing the dragon leukoencephalopathy
- posterior reversible encephalopathy syndrome
- 1. Jasne AS, Alsherbini KH, Smith MS, Pandhi A, Vagal A, Kanter D. Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion (CHANTER) Syndrome. (2019) Neurocritical care. 31 (2): 288-296. doi:10.1007/s12028-018-00666-4 - Pubmed
- 2. Mallikarjun K, Parsons M, Nigogosyan Z, Goyal M, Eldaya R. Neuroimaging Findings in CHANTER Syndrome: A Case Series. AJNR Am J Neuroradiol. 2022;43(8):1136-41. doi:10.3174/ajnr.a7569 - Pubmed