To review the clinical presentation and imaging findings of CHANTER syndrome by presenting a case in a 30 year old female with a history of opiate abuse. 

We describe the clinical presentation, management and outcome of one case of CHANTER syndrome treated in our tertiary care academic medical center during June 2020. The patient, a 30-year-old, obese, Caucasian female with a history of polysubstance abuse, was found down in an unresponsive state.  Initial CTH showed hypodensities in bilateral cerebellar hemispheres with tonsillar herniation. MRI demonstrated symmetric diffusion restriction in BL cerebellar hemispheres, subcortical occipital lobes, frontoparietal regions, fornicies, basal ganglia, and hippocampi.   She was admitted to the neurocritical care unit and the cerebral edema was aggressively treated with hypertonic saline.  With close neurological monitoring and aggressive medical therapy, surgical decompression was not needed for treatment of cerebral edema and she demonstrated dramatic clinical improvement.  She was extubated on hospital day two and on hospital day three she was transferred out of the ICU.  Prior to discharge, her only residual deficit was mild right leg weakness for which she was discharged to inpatient rehabilitation.

This case demonstrates the unique and under-recognized manifestations and clinical course of CHANTER syndrome and illustrates the potential for significant clinical improvement with early recognition and prompt treatment of the associated transient edema.