P1.006: Case Study: Rapid Diagnosis and Management of CHANTER Syndrome in adolescent male, a multidisciplinary approach with 1yr follow up

Introduction: Opioid toxicity is increasingly prevalent in the pediatric population, partially attributable to the increasing prevalence of Fentanyl outside of the healthcare environment.

Case Description: At a large tertiary care center, a 14-year-old male presented to the emergency department (ED) with altered mental status and Glasgow coma scale of three. The patient’s status did not improve with naloxone administration. On magnetic resonance imaging (MRI) two hours later, the patient was found to have cerebellar, hippocampal, and basal nuclei edema with restricted diffusion, suggestive of CHANTER syndrome. Initial computed tomography (CT) brain imaging was ineffective in reaching this diagnosis. After a prolonged hospital course starting with Glasgow coma scale 3, multiple neurosurgical operations, radiologic discussions, palliative care consults, family care conferences, and extensive physical rehabilitation, the patient made a remarkable recovery.

Discussion: This case illustrates the importance of a multi-disciplinary approach in caring for patients with CHANTER syndrome. Neurosurgical procedures, not typically employed in other cases of opiate overdose, may be necessary to mitigate life-threatening ICP and hydrocephalus, as occurred in this case. Additionally, recovery may be delayed and prolonged, highlighting the essential role of physical medicine and rehabilitation in the care of these patients.

Conclusion: Here we provide a multidisciplinary discussion on the diagnosis, management, and treatment plan for children and adolescents with CHANTER syndrome findings.