Opioid-associated brain injury may involve selective regions, including the hippocampi alone, globi pallidi, and cerebellar hemispheres. Opioid-associated amnestic syndrome, for example, is one clinical correlate of hippocampal injury as manifest by MRI abnormality. When all three regions are involved in what may be a more fulminant injury, the syndrome is termed “cerebellar, hippocampal, and basal nuclei transient edema with restricted diffusion (CHANTER)”, initially described in 2019. Until now, to our knowledge, there have been no histopathologic correlates to the imaging findings specifically in CHANTER syndrome. Here, for the first time, we present histopathologic findings of the post-mortem brain from a patient who died from complications of CHANTER syndrome following fentanyl intoxication. These observations included microhemorrhage, reactive and necrotic vasculature, eosinophilic neuronal necrosis, axonal swelling and spheroids, and frank infarction. The findings support previous experimental models implicating both hypoxic–ischemic and cytotoxic mechanisms in the tissue damage associated with CHANTER syndrome, though further work is needed to better characterize the exact cellular pathways involved to develop targeted treatments.

阿片类药物相关的脑损伤可能涉及选择性区域，包括海马体、苍白球和小脑半球。例如，阿片类药物相关的遗忘综合征是海马损伤的一种临床相关因素，如 MRI 异常所示。当所有三个区域都参与可能更为严重的损伤时，该综合征被称为“小脑、海马和基底核短暂性水肿伴扩散受限 (CHANTER)”，最初于 2019 年描述。到目前为止，据我们所知，有没有组织病理学与影像学结果相关，特别是在 CHANTER 综合征中。在这里，我们首次展示一名因芬太尼中毒后 CHANTER 综合征并发症而死亡的患者的死后大脑组织病理学结果。这些观察结果包括微出血、反应性和坏死的脉管系统、嗜酸性神经元坏死、轴突肿胀和球状体以及明显的梗塞。这些发现支持了先前的实验模型，表明与 CHANTER 综合征相关的组织损伤中存在缺氧缺血和细胞毒性机制，尽管还需要进一步的工作来更好地表征开发靶向治疗所涉及的确切细胞途径。