To discuss the clinical presentation and radiographic findings of a young patient with CHANTER syndrome and highlight the possibility of good clinical outcome.

CHANTER syndrome is an emerging clinico-radiographic entity affecting patients with drug use, particularly opioids. Patients typically present with acute encephalopathy with characteristic MRI findings. Only a few cases have been reported with varying outcomes. We believe that awareness of CHANTER syndrome is important for early recognition, and aggressive medical and surgical treatment which can potentially result in significant recovery despite seemingly devastating initial clinical and radiological presentation.

Case report.

We present a case of 25-year-old male with polysubstance use and no other medical history, who was brought into the hospital after being found down unconscious. On initial evaluation his GCS was 3, with preserved brainstem reflexes. He was intubated for airway protection and admitted to the Neuro-ICU.  Lab was notable for mild leukocytosis and lactic acidosis. UDS was positive for fentanyl and amphetamines. Initial CTH showed hypodensities in bilateral cerebellar hemispheres and basal ganglia. MRI showed symmetric diffusion restriction involving bilateral cerebellum, basal ganglia, forniceal columns, subcortical occipital, and frontoparietal regions. On day 3, patient developed obstructive hydrocephalus despite treatment with hypertonic solutions. An EVD was placed that resulted in slow improvement in the neurological exam over the following days. The EVD was removed on day 18. He was maintained on fentanyl infusion that was weaned off to prevent withdrawal symptoms.  Patient had significant clinical and radiographic improvement. He required short-term tracheostomy and PEG placement. After receiving inpatient rehabilitation, he was discharged home on day 58. At 2 months follow-up, his only deficit was mild right sided weakness and ataxia. He was verbal, ambulatory, and independent in his ADLs.

This case illustrates the potential for significant clinical improvement with early recognition and prompt treatment of CHANTER syndrome.