Case 324: CHANTER Syndrome.
Pokhraj Prakashchandra SutharKathryn HughesMustafa MafrajiMelih AkyüzMiral D JhaveriSumeet G DuaPublished in: Radiology (2024)
A 69-year-old right-handed man with a history of substance use disorder, hypertension, and diabetes presented to the emergency department in an unresponsive state. Upon examination, apart from tachycardia (heart rate, 108 beats per minute), vital signs were within normal ranges (blood pressure, 134/102 mm Hg; temperature, 97.9 ºF (36.6 ºC); respiratory rate, 16 per minute; oxygen saturation, 96%). The patient had a Glasgow coma scale score of 8. Otherwise, the physical examination revealed no abnormalities. Prior psychiatric and surgical histories were unremarkable. There was no history of recent travel, camping, hiking, or vaccination. No family history could be obtained. Laboratory work-up revealed an elevated creatine kinase level (49 006 U/L [818.4 μkat/L]; normal reference range, 10-205 U/L [0.17-3.42 μkat/L]). An electrocardiogram showed sinus tachycardia without evidence of cardiac ischemia. An echocardiogram was unremarkable. Alanine aminotransferase (126 U/L [2.10 μkat/L]; normal reference range, 0-40 U/L [0-0.67 μkat/L]) and aspartate aminotransferase (488 U/L [8.15 μkat/L]; normal reference range, 3-44 U/L [0.05-0.74 μkat/L]) levels were elevated. Polymerase chain reaction results were negative for HIV-1, HIV-2, syphilis treponemal, and COVID-19 antibodies. The remaining routine laboratory work-up findings were within normal limits. Urine drug screening was positive for cocaine, marijuana, fentanyl, and benzodiazepines. Naloxone was administered, but the patient remained unresponsive. Intubation was performed for airway protection. Noncontrast and contrast-enhanced CT of the head and CT angiography were performed in the emergency department to rule out an acute intracranial abnormality. Multisequence MRI of the brain with administration of intravenous contrast material was ordered for further assessment. CT of the abdomen and pelvis was unremarkable (images not shown).
Keyphrases
- contrast enhanced
- blood pressure
- emergency department
- heart rate
- diffusion weighted
- magnetic resonance imaging
- computed tomography
- magnetic resonance
- dual energy
- human immunodeficiency virus
- diffusion weighted imaging
- antiretroviral therapy
- case report
- hiv positive
- mental health
- heart rate variability
- hiv infected
- hiv testing
- men who have sex with men
- cardiovascular disease
- sars cov
- hepatitis c virus
- coronavirus disease
- liver failure
- hypertensive patients
- single cell
- adverse drug
- convolutional neural network
- drug induced
- deep learning
- physical activity
- white matter
- left ventricular
- image quality
- cardiac arrest
- low dose
- catheter ablation
- clinical practice
- tyrosine kinase
- metabolic syndrome
- functional connectivity
- subarachnoid hemorrhage
- glycemic control
- brain injury
- optical coherence tomography
- multiple sclerosis
- blood glucose
- resting state
- heart failure
- electronic health record
- positron emission tomography
- insulin resistance