CLIPPERS: a recognizable image of a treatable disease

An 80-year-old man with a history of stroke presented with eyelid ptosis of three years' duration. Magnetic resonance imaging (MRI) of the brain revealed findings consistent with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). As limitat...

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Bibliographic Details
Published in:Arquivos de neuro-psiquiatria 2019-12, Vol.77 (12), p.903-904
Main Authors: Mello, Denise Fabri Rezende Engracia, Queiroz, Rodolfo Mendes, Miyake, Cecilia, Fábio, Soraia Ramos Cabette, Abud, Lucas Giansante
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Aged, 80 and over
Biopsy
Brain Stem - diagnostic imaging
Brain Stem - pathology
Chronic Disease
Corticosteroids
Diagnosis, Differential
Differential diagnosis
Encephalomyelitis - diagnostic imaging
Encephalomyelitis - drug therapy
Encephalomyelitis - pathology
Eyelid
Glymphatic System - diagnostic imaging
Humans
Lymphoma
Magnetic resonance imaging
Magnetic Resonance Imaging - methods
Male
Neuroimaging
Neurosyphilis
Steroid hormones
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Summary:An 80-year-old man with a history of stroke presented with eyelid ptosis of three years' duration. Magnetic resonance imaging (MRI) of the brain revealed findings consistent with chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). As limitations precluded anatomopathological examination and the imaging pattern was characteristic enough to support treatment without biopsy, the decision was made to prescribe long-term corticosteroids. At the two-year follow-up, MRI findings had regressed and the patient had improved clinically, meeting criteria for treatment response. Biopsy is indicated when symptoms and MRI findings are unresponsive to treatment. The differential diagnosis should include CNS lymphoma, neurosyphilis, and vasculitides.
ISSN:0004-282X
1678-4227
DOI:10.1590/0004-282X20190170