CLIPPERS syndrome following papillary thyroid carcinoma

Abstract

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a brainstem syndrome marked by punctate 'pepper-and-salt' enhancement on MRI and corticosteroid responsiveness. Evidence suggests that CLIPPERS may represent a cancer-related immune reaction, occurring before tumour detection, in association with active malignancy or after treatment. We report the first case associated with papillary thyroid carcinoma (PTC). A middle-aged woman developed facial numbness and ataxia; MRI showed pontocerebellar enhancement, and work-up revealed PTC. Neurological signs resolved after total thyroidectomy. Sixteen months later, neurological symptoms recurred. Repeat MRI reproduced the CLIPPERS pattern. High-dose intravenous methylprednisolone followed by a short taper induced rapid and sustained clinical and radiological remission. Serial neck ultrasound and serum thyroglobulin measurements confirmed no evidence of PTC recurrence. This case illustrates that CLIPPERS can precede, remit after and recur independently of cancer activity, highlighting the importance of comprehensive malignancy screening and long-term oncological surveillance.

Keywords: Brain stem / cerebellum; Magnetic Resonance Imaging; Neuroimaging.