PDF(Pubmed)
Abstract：
BACKGROUND: CHANTER (Cerebellar Hippocampal and Basal Nuclei Transient Edema with Restricted diffusion) is a recently described syndrome occurring in the context of drug abuse. While clinical findings are rather unspecific (disorientation, unresponsiveness), MR imaging (MRI) discloses a characteristic pattern (restricted diffusion in the basal ganglia and hippocampi, cerebellar oedema and haemorrhage), allowing for timely diagnosis before complications such as cerebellar swelling and herniation do occur. Here we report a case of CHANTER primarily based on imaging findings, as there was no evidence of drug abuse on admission.
METHODS: A 62-year-old Patient was admitted to our hospital after being unresponsive at home. Prehospital intubation was performed, which limited neurological assessment. Under these circumstances no obvious symptoms could be determined, i.e. pupils were isocoric and responsive, and there were no signs of seizures. While the initial CT scan was unremarkable, the subsequent MRI scan showed a distinct imaging pattern: moderately enhancing areas in the basal ganglia and hippocampi with diffusion restriction, accompanied by cerebellar haemorrhage and oedema (Figs. 1 and 2). A comprehensive clinical and laboratory work-up was performed, including drug screening, spinal tap, Holter ECG, echocardiography and EEG. The only conspicuous anamnestic finding was a chronic pain syndrome whose medication had been supplemented with opioids two months previously. The opioid medication was discontinued, which led to a rapid improvement in the patient\'s clinical condition without any further measures. The patient was able to leave the intensive care unit and was discharged 10 days after admission without persistent neurological deficits.
CONCLUSIONS: Familiarity with typical MRI patterns of toxic encephalopathy in patients from high-risk groups, such as drug abusers, is crucial in emergency neuroradiology. In the presence of typical MRI findings, CHANTER syndrome should be included in the differential diagnosis, even if there is no history of drug abuse, to avoid delay in diagnosis and treatment.
METHODS: A 62-year-old Patient was admitted to our hospital after being unresponsive at home. Prehospital intubation was performed, which limited neurological assessment. Under these circumstances no obvious symptoms could be determined, i.e. pupils were isocoric and responsive, and there were no signs of seizures. While the initial CT scan was unremarkable, the subsequent MRI scan showed a distinct imaging pattern: moderately enhancing areas in the basal ganglia and hippocampi with diffusion restriction, accompanied by cerebellar haemorrhage and oedema (Figs. 1 and 2). A comprehensive clinical and laboratory work-up was performed, including drug screening, spinal tap, Holter ECG, echocardiography and EEG. The only conspicuous anamnestic finding was a chronic pain syndrome whose medication had been supplemented with opioids two months previously. The opioid medication was discontinued, which led to a rapid improvement in the patient\'s clinical condition without any further measures. The patient was able to leave the intensive care unit and was discharged 10 days after admission without persistent neurological deficits.
CONCLUSIONS: Familiarity with typical MRI patterns of toxic encephalopathy in patients from high-risk groups, such as drug abusers, is crucial in emergency neuroradiology. In the presence of typical MRI findings, CHANTER syndrome should be included in the differential diagnosis, even if there is no history of drug abuse, to avoid delay in diagnosis and treatment.
摘要：
背景：CHANTER（小脑海马和基底核短暂性水肿，弥散受限）是最近描述的在药物滥用背景下发生的综合征。虽然临床发现相当没有特异性(迷失方向，无响应)，MR成像（MRI）公开了一种特征模式（基底神经节和海马中的受限扩散，小脑水肿和出血)，允许在小脑肿胀和疝等并发症发生之前及时诊断。在这里，我们报告了一个CHANTER病例，主要基于影像学发现，因为入院时没有药物滥用的证据。
方法：一名62岁患者因在家无反应而入院。进行院前插管,这限制了神经系统的评估。在这种情况下，无法确定明显的症状，即瞳孔是等心和反应灵敏的，也没有癫痫发作的迹象.虽然最初的CT扫描并不明显，随后的MRI扫描显示了明显的成像模式：基底神经节和海马的中度增强区域，弥散受限，伴有小脑出血和水肿（图。1和2）。进行了全面的临床和实验室检查，包括药物筛选,脊髓水龙头,动态心电图,超声心动图和脑电图。唯一明显的记忆障碍发现是一种慢性疼痛综合征，其药物在两个月前已补充了阿片类药物。阿片类药物被停用,这导致患者的临床状况迅速改善，没有任何进一步的措施。患者能够离开重症监护病房，并在入院后10天出院，没有持续的神经功能缺损。
结论：熟悉高危人群中毒性脑病的典型MRI模式，比如吸毒者，在紧急神经放射学中至关重要。在有典型的MRI检查结果的情况下,CHANTER综合征应包括在鉴别诊断中，即使没有药物滥用史，避免延误诊断和治疗。
方法：一名62岁患者因在家无反应而入院。进行院前插管,这限制了神经系统的评估。在这种情况下，无法确定明显的症状，即瞳孔是等心和反应灵敏的，也没有癫痫发作的迹象.虽然最初的CT扫描并不明显，随后的MRI扫描显示了明显的成像模式：基底神经节和海马的中度增强区域，弥散受限，伴有小脑出血和水肿（图。1和2）。进行了全面的临床和实验室检查，包括药物筛选,脊髓水龙头,动态心电图,超声心动图和脑电图。唯一明显的记忆障碍发现是一种慢性疼痛综合征，其药物在两个月前已补充了阿片类药物。阿片类药物被停用,这导致患者的临床状况迅速改善，没有任何进一步的措施。患者能够离开重症监护病房，并在入院后10天出院，没有持续的神经功能缺损。
结论：熟悉高危人群中毒性脑病的典型MRI模式，比如吸毒者，在紧急神经放射学中至关重要。在有典型的MRI检查结果的情况下,CHANTER综合征应包括在鉴别诊断中，即使没有药物滥用史，避免延误诊断和治疗。
