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Case Reports
. 2023 May 29:11:2050313X231177168.
doi: 10.1177/2050313X231177168. eCollection 2023.

CLIPPERS manifesting with dizziness: Recognizable and treatable

Yahya El Harras  1 , Safaa Choayb  1 , Kenza Berrada  1 , Meryem Fikri  1 , Najwa Ech-Cherif Kettani  1 , Mohamed Jiddane  1 , Firdaous Touarsa  1
Affiliations
Case Reports

CLIPPERS manifesting with dizziness: Recognizable and treatable

Yahya El Harras et al. SAGE Open Med Case Rep. .

Abstract

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids is a very rare entity which is considered as a treatable condition. In some cases, clinical and radiological findings, associated to favorable evolution on steroids therapy can be sufficiently distinguishable to diagnose chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. We report the case of a 50-year-old man, suffering from acute dizziness with right facial paralysis and limited ocular abduction with his magnetic resonance imaging showing large confluent T2 and fluid-attenuated inversion recovery brainstem hyperintensities extending into the upper cervical spinal cord, infiltrating the basal ganglia and the thalami, with some punctate hyperintensities "peppering" the medial aspects of cerebellar hemispheres. This case illustrates atypical imaging features of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids on magnetic resonance imaging and our work also reviews different studies in the literature and highlights the differential diagnosis.

Keywords: CLIPPERS; brainstem; corticosteroid therapy; inflammation; magnetic resonance imaging.

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Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
(a) Axial T2 and (b, c, and d) 3D FLAIR images showing large confluent hyperintensities in the middle stem, pons extending into the upper cervical spinal cord (red arrows). It infiltrates the basal ganglia and the thalami, with some punctate hyperintensities “peppering” the medial aspects of cerebellar hemispheres.
Figure 2.
Figure 2.
T1 FAT SAT with gadolinium injection shows punctate and curvilinear foci of contrast enhancement. Note extension into supratentorial paraventricular white matter (red arrow).
Figure 3.
Figure 3.
(a) Axial SWI MIP shows multiple hemorrhagic foci in the middle brain. (b) and (c) Diffusion-weighted sequences with apparent diffusion coefficient (ADC) cartography showing scattered curvilinear restricted diffusion areas (arrows).
See this image and copyright information in PMC

References

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