A 44-year-old man with alcohol use disorder presented with unresponsiveness. Toxicology was positive for cocaine and fentanyl. Brain MRI showed multiple foci of restricted diffusion and extensive edema in the cerebellum, hippocampus, and basal ganglia (Figure). Imaging findings suggested cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER) syndrome, a rare radiographic pattern observed in acute intoxication.¹ Diagnosis is based on these specific MRI findings. In contrast to anoxic-ischemic injury, patients exhibit relative sparing of the cerebral cortex and subcortical white matter. Early recognition allows for aggressive edema management and may obviate unnecessary testing or inappropriate treatment. Prognosis is variable with reports ranging from complete recovery to progressive cerebellar edema and herniation.² In this case, despite hyperosmolar therapy, ventriculostomy placement, and suboccipital craniectomy, the patient's clinical status continued to deteriorate. He died after transition to comfort measures only.

一名患有酒精使用障碍的 44 岁男子出现反应迟钝。毒理学结果显示可卡因和芬太尼呈阳性。脑 MRI 显示小脑、海马和基底神经节有多个弥散受限和广泛水肿的病灶（图）。影像学结果提示小脑、海马和基底核短暂性水肿伴弥散受限（CHANTER）综合征，这是急性中毒时观察到的一种罕见的放射学模式。¹诊断基于这些特定的 MRI 结果。与缺氧缺血性损伤相反，患者的大脑皮层和皮层下白质相对较少。早期识别可以进行积极的水肿管理，并可以避免不必要的测试或不适当的治疗。预后各不相同，报告范围从完全恢复到进行性小脑水肿和脑疝。²在该病例中，尽管进行了高渗治疗、脑室造口术和枕下颅骨切除术，但患者的临床状况继续恶化。他在仅采取安慰措施后去世。