The Rehabilitation Course of an Adolescent with CHANTER Syndrome

Case Diagnosis: Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted Diffusion (CHANTER) Syndrome

Case Description or Program Description: A 17-year-old male with a past medical history of polysubstance use presented to an emergency department with altered mental status, nystagmus, weakness, ataxia, and intractable emesis one week after consuming a “magic mushroom” chocolate bar. Brain MRI demonstrated multiple foci of restricted diffusion and edema in the cerebellum, hippocampus, and basal ganglia, further complicated by mild cerebellar herniation resulting in obstructive hydrocephalus. He was ultimately determined to have CHANTER syndrome and was treated with external ventricular drain placement.

Setting: Acute Inpatient Rehabilitation

Assessment/Results: Initially his ataxia and weakness made gait evaluation unsafe, but six weeks after his acute care presentation he walked four steps with maximal assistance. By his twelfth week he was walking 440 feet with minimal assistance with the use of a rolling walker. His upper body dressing required moderate assistance his first week, progressed to minimal assistance his eleventh week, and is now modified independent in his twelfth week. Cognitively, this patient was unable to complete an orientation log in his first week, but he completed with a passing score in his fifth week. His altered mental status, weakness, and ataxia contributed to dysphagia, and he required nasogastric tube feeding on admission. However, he began an oral diet in his third week, and the tube feeds ceased in his eighth week.

Discussion (relevance): CHANTER syndrome is a rare constellation of radiologic and clinical findings with a strong association with opiates. A review of the literature found only one other pediatric case report, and a total of 16 case reports on PubMed. There are few descriptions of recovery from CHANTER syndrome, limiting prognostication and guidance for rehabilitation.

Conclusions: This case describes the recovery course of one adolescent with CHANTER syndrome. Further research can provide support for prognosis and guide rehabilitative efforts.