CLIPPERS: a recognizable image of a treatable disease

Abstract

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 (Figure 1) 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 (Figure 2) and the patient had improved clinically, meeting criteria for treatment response 1. Biopsy is indicated when symptoms and MRI findings are unresponsive to treatment 2. The differential diagnosis should include CNS lymphoma, neurosyphilis, and vasculitides 3,4 .