Sixteen percent of ALL survivors had VIPN. VIPN should be increasingly recognised as a late effect of chemotherapy, as it significantly affects physical and social function quality of life.

Acute necrotizing encephalopathy (ANE) in childhood is a rare clinico-radiological syndrome with distinctive bilateral thalamic lesions. The diagnosis is often based on the criteria proposed by Mizuguchi et al. 1 It comprises a spectrum of virus-associated encephalopathy, 2 often but not exclusively associated with influenza infection and a familial and a relapsing form have been reported. The mortality rates are varied, ranging from 0% to 43% and survivors often have severe disabilities. [3][4][5][6][7][8] Whilst there is no clear consensus for ANE treatment, 9 the key therapeutic strategy is the early initiation of firstline immunotherapy, particularly of corticosteroids. 4,9 More C

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare neuro-inflammatory disorder with only 10 pediatric cases reported worldwide. The diagnostic criteria proposed in 2017 [1] require clinical criteria (pontocerebellar dysfunction with an exquisite response to steroids, in the absence of peripheral neurological disease and other explainable etiology) and radiological criteria (homogenous gadolinium-enhancing nodules of less than 3 mm, predominantly in the perivascular regions of pons and cerebellum, which resolve with steroid therapy) to be fulfilled for probable CLIPPERS and additional histopathological criteria (lymphocytic, predominantly T-cells, infiltrating perivascular sites) for definite CLIPPERS. In 2019, revised criteria [2] that included a change in the size of the nodules to less than 9 mm, were proposed to improve diagnostic specificity. CLIPPERS has different outcomes between children and adults, as at least 30% of pediatric cases were associated with alternative diagnoses such as familial hemophagocytic lymphohistiocytosis (fHLH) and 20% had residual severe disabilities [2,3].We report a case of probable pediatric CLIP-PERS with a good outcome in a patient who presented with acute cerebellar signs and classical post-gadolinium brain magnetic resonance imaging (MRI) features of punctate lesions of the hindbrain and responded exquisitely to steroids. He was also screened for fHLH, and no known genetic mutations were detected.A previously well 10-year-old boy presented with a 1-week history of progressive headache, diplopia, and unsteady gait, with no other neurological or systemic symptoms. There was a history of pancytopenia attributed to viral illness 3 years ago that had self-resolved. On examination, he was afebrile and had a full Glasgow Coma Scale score with appropriate behaviour for his age. He had truncal ataxia and a broad-based gait with past pointing, dysdiadochokinesia, and intentional tremors bilaterally. There was no ophthalmoplegia, fundoscopy showed no optic neuritis or papilledema, all other cranial nerves were intact, and the tone, power, and reflexes of both upper and lower limbs were normal. There was no hepatosplenomegaly or lymphadenopathy, and the findings of other systemic examinations were normal.Investigations were conducted with the aim of ruling out infection, posterior circulation stroke, demyelination, or malignancy. His full blood