SHM Converge Scientific Abstract ePoster Gallery-Recognizing Cerebellar Hippocampal and Basal Nuclei Transiet Edema With Restricted Diffusion Syndrome in the Setting of Fentanyl-Associated Cardiac Arrest: A Clinical Vignette

Recognizing Cerebellar Hippocampal and Basal Nuclei Transiet Edema With Restricted Diffusion Syndrome in the Setting of Fentanyl-Associated Cardiac Arrest: A Clinical Vignette

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This clinical vignette describes a 28-year-old woman with bipolar disorder and polysubstance use who suffered fentanyl-associated cardiac arrest with aspiration and coma. After 9 minutes of CPR, she had GCS 3, vasoplegic shock, and imaging initially concerning for hypoxic-ischemic brain injury. However, MRI revealed the characteristic pattern of CHANTER syndrome: restricted diffusion involving the cerebellum, hippocampi, and bilateral globus pallidi, with some superimposed hypoxic-ischemic changes.<br /><br />CHANTER syndrome (Cerebellar-Hippocampal-Basal Nuclei Transient Edema with Restricted Diffusion) is a recently recognized toxic encephalopathy associated with opioid use and altered mental status. It is important to identify because it can be mistaken for devastating anoxic injury or stroke, yet patients may recover substantially with supportive care.<br /><br />The patient was treated in the ICU with targeted temperature management, antibiotics, and respiratory support. She required prolonged ventilation, tracheostomy, and PEG placement, but gradually improved neurologically. By about one month, she was off the ventilator, taking oral nutrition, and had only mild to moderate speech delay. At three months, she continued to recover and had her PEG removed.<br /><br />The learning points emphasize:<br />- Recognizing the typical clinical presentation of CHANTER syndrome<br />- Identifying its distinctive MRI findings<br />- Differentiating it from hypoxic-ischemic encephalopathy, ischemic stroke, and heroin-associated leukoencephalopathy<br /><br />Overall, the vignette highlights that in fentanyl-related overdose or cardiac arrest, CHANTER syndrome should be considered when MRI shows the classic cerebellar, hippocampal, and basal nuclei involvement, as prognosis and management differ from other causes of coma.

Asset Subtitle

Samuel D. Ross

Meta Tag

Author List Lucas Hopkins, Samuel D. Ross

Category Clinical Vignettes

Concept CHANTER Syndrome

Concept Overdose

Concept Restricted Diffusion

Concept Cardiac Arrest

Concept Altered Mental Status

Distinguished Non-Finalist

Presenter Organization Wellstar Kennestone

Presenting Author Samuel D. Ross

Track Adult

Keywords

CHANTER syndrome

fentanyl overdose

cardiac arrest

toxic encephalopathy

restricted diffusion

cerebellum

hippocampi

globus pallidi

hypoxic-ischemic injury

MRI findings

CHANTER Syndrome

Overdose

Restricted Diffusion

Cardiac Arrest

Altered Mental Status