Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER): A Case Report with Literature Review (P9-7.004)

Abstract

<h3>Objective:</h3> To review the clinical presentation and imaging findings of a 64-year-old patient with CHANTER syndrome. <h3>Background:</h3> Cerebellar hippocampal and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome is a rarely described constellation of neuroradiographic findings in the setting of altered mental status. Patients typically present after being found unresponsive in the setting of polysubstance abuse. While the imaging findings associated with CHANTER (restricted diffusion in the bilateral cerebellum, limbic structures, and corpus striatum) are often harbingers of severe brain injury, a growing number of case reports have shown that patients with this syndrome may demonstrate marked clinical improvement over time. <h3>Design/Methods:</h3> Case report with literature review. <h3>Results:</h3> Our patient is a 64-year-old woman who presented to our academic tertiary care center after being found unresponsive. On presentation her GCS was 3 and her urine drug screen was positive for cocaine, fentanyl, barbiturates, and opiates. Fingerstick glucose was over 500 by EMS and she was intubated in the emergency room. The patient was admitted to the MICU where her hospital course was complicated by shock, AKI, acute on chronic respiratory failure, and persistent encephalopathy. Follow-up neuroimaging showed worsening hydrocephalus with areas of signal abnormality and diffusion restriction in the bilateral hippocampi and cerebellar hemispheres, consistent with CHANTER Syndrome. She received hypertonic saline, an EVD was placed, and she underwent suboccipital craniectomy to further relieve intracranial pressure. She was ultimately discharged on hospital day 29 with residual cognitive deficits to an acute rehabilitation facility. <h3>Conclusions:</h3> We report a case of CHANTER Syndrome in a 64-year-old woman who was successfully treated with hypertonic saline and urgent suboccipital craniectomy. This case supports the growing cohort of studies that describe the unique clinical and radiological course of CHANTER Syndrome. <b>Disclosure:</b> Ms. Menville has nothing to disclose. Mr. Wang has nothing to disclose. Dr. Weisbach has nothing to disclose. Dr. Tung has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Up to Date. Dr. Tung has received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Leeseberg &amp; Valentine. Dr. Tung has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Cooper &amp; Elliott. The institution of Dr. Richards has received research support from Brown Physicians, Inc.