CHANTER Syndrome: A Pediatric Case Report

Case Diagnosis: A 23 month old girl with cerebellar, hippocampal, and basal ganglia transient edema with restricted diffusion (CHANTER) syndrome

Case Description or Program Description: This patient developed CHANTER syndrome following accidental fentanyl exposure, complicated by obstructive hydrocephalus and cerebellar herniation. Neurosurgery was consulted and performed a decompressive suboccipital craniectomy, C1 laminectomy with expansion duraplasty, and cerebellar resection. Following surgery, she was admitted to the pediatric intensive care unit (PICU). Magnetic resonance imaging demonstrated edema in bilateral hippocampal lobes and cerebellar hemispheres. Her hospital course was complicated by seizure-like activity requiring anti-epileptic drugs.

Setting: Acute care hospital

Assessment/Results: On postoperative day (POD) 3, the patient was extubated. She had no head or trunk righting when moved from supine to sitting and remained nil per os, requiring nasogastric tube (NGT) feeds. On POD 4 she was transferred from the PICU to the floor and oral intake was initiated. On POD 8, she had fair static and dynamic sitting balance and required minimal assistance transitioning from sit to stand. On POD 10, NGT was removed. She could sit with supervision, take steps with stand-by-assistance, hold her bottle, and feed herself. On POD 11, she could ambulate 3 feet and transfer from sit to stand with supervision. Due to good functional improvement and family’s wishes, the patient was discharged home with plans to continue therapies outpatient.

Discussion (relevance): CHANTER syndrome has primarily been described in adults, with only 1 case in a pediatric patient. With increasing rates of pediatric opiate overdoses, awareness of this syndrome can help streamline initiation of treatments, minimizing complications and long-term disability. With more reports, we can gain a better understanding of patients’ prognoses for functional recovery and possible rehabilitation needs.

Conclusions: CHANTER syndrome is a distinct clinicoradiologic diagnosis that can manifest in children. Good functional recovery is possible, although more research is needed for greater generalization of functional prognosis.