Cerebellar, hippocampal, and basal nuclei transient oedema with restricted diffusion (CHANTER) syndrome
Updates to Article Attributes
Cerebellar, hippocampal, and basal nuclei transient edemaoedema with restricted diffusion (CHANTER) syndrome is a recently described constellation of imaging findings in adults with opioid neurotoxicity. It is characterizedcharacterised by cytotoxic edemaoedema in the bilateral hippocampi and cerebellar cortices, and variably in the basal ganglia 1.
This entity likely falls within a pathophysiologic spectrum with pediatricpaediatric opioid use‐associated neurotoxicity with cerebellar edemaoedema (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.
Epidemiology
A single case series of six patients has been reported 1.
Clinical presentation
Patients present with a decreased level of consciousness 1,2.
Radiographic features
Imaging shows cerebellar edemaoedema, which progressesmay progress to cause hydrocephalus2. 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 spared1.
History and etymology
The syndrome was first described by an American group of clinicians in a seminal case series in 2019 1.
Differential diagnosis
- hypoxic-ischaemic 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
References changed:
- 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. <a href="https://doi.org/10.3174/ajnr.a7569">doi:10.3174/ajnr.a7569</a> - <a href="https://www.ncbi.nlm.nih.gov/pubmed/35798385">Pubmed</a>
Image 1 MRI (DWI) ( create )
Unable to process the form. Check for errors and try again.
