Document Detail

CLIPPERS syndrome with atypical distribution of lesions in magnetic resonance imaging of the brain.
MedLine Citation:
PMID:  24081890     Owner:  NLM     Status:  Publisher    
INTRODUCTION. CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory process of the central nervous system whose distinguishing features are the enhancing punctiform lesions in the brainstem that appear in the magnetic resonance images. Clinically, it is accompanied by dysarthria, ataxia and diplopia, and usually responds to treatment with corticoids. Pathologically, T lymphocytes appear infiltrated in the perivascular spaces of the brainstem. CASE REPORT. We report the case of a 40-year-old woman with an initial subacute clinical picture of binocular diplopia, ataxia and dysarthria. The magnetic resonance brain scan revealed T2 hyperintense punctiform lesions in the stem, cerebellum, diencephalons and cortico-subcortical areas of both hemispheres, which were enhanced with contrast. An aetiological study was performed to rule out any underlying infectious, neoplastic or inflammatory origin, the results being negative. The patient was treated on two occasions with methylprednisolone, with a gradual lowering of the dosage, the response being favourable. CONCLUSIONS. Diplopia and ataxia, as in our case, are practically always present. The MR findings consist of punctiform enhancing lesions located in the pons extending towards the cerebellum, basal ganglia and corpus callosum, the enhancement gradient becoming lower as the distance increases rostrally away from the cortex, and caudally towards the spinal cord. In the case of our patient, this gradient is not respected, and the density found was similar to that of lesions at the supratentorial level. The differential diagnosis is wide-ranging and justifies an extensive diagnostic study with, in certain cases, a biopsy study of brain tissue. The disease courses in a relapsing-remitting pattern and the earlier steroid therapy is established and the more prolonged it is, the better the prognosis will be.
Abstract available from the publisher.
B Canneti; A J Mosqueira; F Gilo; T Carreras; A Barbosa; V Meca-Lallana; J Vivancos
Publication Detail:
Journal Detail:
Title:  Revista de neurologia     Volume:  57     ISSN:  1576-6578     ISO Abbreviation:  Rev Neurol     Publication Date:  2013 Oct 
Date Detail:
Created Date:  2013-10-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7706841     Medline TA:  Rev Neurol     Country:  -    
Other Details:
Languages:  SPA     Pagination:  354-358     Citation Subset:  -    
Hospital Universitario de la Princesa, 28006 Madrid, Espana.
Vernacular Title:
Sindrome CLIPPERS con distribucion atipica de las lesiones en la resonancia magnetica cerebral.
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