Chronic lymphocytic inflammation with Pontine perivascular enhancement responsive to steroids

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Clinic

  • CLIPPERS is a recently defined inflammatory CNS disorder, prominently involving the brainstem and in particular the pons. [1]
  • It most commonly results in subacute diplopia and ataxia
  • Diagnosis is achieved through a triad of the following findings:
    • Lymphocytic pleocytosis with increased CD4+ T cells on cerebrospinal fluid (CSF) analysis;
    • Perivascular punctate and curvilinear hemorrhages in the pons, medulla, or cerebellum on magnetic resonance imaging (MRI) with contrast
    • Cessation of symptoms after the initiation of corticosteroids


  • Here, we report the case of a 23-year-old male who presented with non-specific signs and symptoms, including [2]
    • Diffuse weakness in all limbs
    • Ataxia
    • Slurred speech


Related disease

Brainstem encephalitis

  1. Dudesek A, Rimmele F, Tesar S, Kolbaske S, Rommer PS, Benecke R, Zettl UK. CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders. Clin Exp Immunol. 2014 Mar;175(3):385-96. doi: 10.1111/cei.12204. PMID: 24028073; PMCID: PMC3927899.
  2. Ambia A R, AlZahrani N, Almakadma A, et al. (January 18, 2022) Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive to Steroids: An Acute Presentation. Cureus 14(1): e21382. doi:10.7759/cureus.21382