CLIPPERS complicating multiple sclerosis causing concerns of CNS lymphoma

Ortega, Melissa R.; Usmani, Nida; Parra‐Herran, Carlos; Adams, David J.; Steingo, Brian; Rammohan, Kottil

doi:10.1212/wnl.0b013e3182648b77

Cited by 30 publications

(26 citation statements)

References 6 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We also follow up on the comments of others regarding whether CLIPPERS should be ''considered a prelymphoma state or a new inflammatory disease'' (25) or might ''show possible early monoclonal expansion of B cells'' (26). Our negative results by PCR for monoclonality parallel similar negative tissue biopsy PCR studies in 2 CLIPPERS patients reported by Kastrup et al (4) and 1 reported by Ortega et al (15).…”

supporting

confidence: 91%

“…Salivary gland biopsy in the case reported by Biotti et al (11) was normal. Other unusual individual patients with otherwise radiographically typical CLIPPERS have manifested elevated IgE (4,12), peripheral nerve abnormalities on nerve conduction studies (12), multiple sclerosis with onset of CLIPPERS after withdrawal of drug therapies (15,21), temporal association with influenza vaccination (13), primary central nervous system lymphoma (9,17), or even glioma-like biopsy features (6). Kira (23) has questioned whether CLIPPERS is a single disease or a syndrome and Keegan made the critical point that until specific markers are identified for CLIPPERS, it may be impossible to answer the question (24).…”

mentioning

confidence: 99%

See 1 more Smart Citation

CLIPPERS With Chronic Small Vessel Damage: More Overlap With Small Vessel Vasculitis?

Kleinschmidt‐DeMasters¹,

West²

2014

J Neuropathol Exp Neurol

View full text Add to dashboard Cite

supporting

confidence: 91%

mentioning

confidence: 99%

CLIPPERS With Chronic Small Vessel Damage: More Overlap With Small Vessel Vasculitis?

Kleinschmidt‐DeMasters¹,

West²

2014

J Neuropathol Exp Neurol

View full text Add to dashboard Cite

“…Hillesheim et al [10] reported a case of CLIPPERS following influenza vaccination. Ortega et al [11] described a patient with MS who developed CLIPPERS shortly after natalizumab withdrawal. Mashima et al [12] reported a case who developed CLIPPERS after treatment for Hodgkin's lymphoma.…”

Section: Discussionmentioning

confidence: 99%

“…Differential diagnoses of CLIPPERS include CNS lymphoma, lymphomatoid granulomatosis, CNS infections, neurosarcoidosis, neuro-Behçet's disease, Sjögren's syndrome, MS, NMO, primary angiitis of the CNS, CNS histiocytosis, acute disseminated encephalomyelitis, Bickerstaff brainstem encephalitis, other inflammatory demyelinating CNS diseases, other autoimmune encephalitides, brainstem tumors, and paraneoplastic disorders. [1,2,10,11,7,31,39,40,41,32,42,43,6] …”

Section: Discussionmentioning

confidence: 99%

Horizontal eyeball akinesia as an initial manifestation of CLIPPERS

et al. 2016

View full text Add to dashboard Cite

Background:Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare chronic inflammatory disorder in the central nervous system (CNS), which is characterized by magnetic resonance imaging (MRI) appearance with punctate and curvilinear gadolinium enhancement “peppering” the pons. Lesions of CLIPPERS mainly involve the pons and the cerebellum. Adjacent structures such as the medulla and the midbrain may also be involved. It is proposed that CLIPPERS is an immune-mediated inflammatory condition characteristic of T-cell-predominant infiltrates and good responsiveness to corticosteroids.Methods and Results:We report a 46-year-old woman who presented with horizontal eyeball akinesia and gait ataxia with characteristic MRI features of CLIPPERS. The possible pathogenesis, clinical manifestations, imaging features, treatment, and prognosis of this peculiar disorder are summarized.Conclusion:This report contributes to the clinical understanding of CLIPPERS which may present with horizontal eyeball akinesia as an initial manifestation. The characteristic presentation of a subacute cerebellar and brainstem syndrome and pepper-like gadolinium enhancement was confirmed in this report. Long-term immunosuppressive treatment seems to be mandatory to sustain improvement. Azathioprine alone may be capable of maintaining remission.

show abstract

“…The underlying pathogenesis of CLIPPERS may also include some autoimmune or hematological disorders. In fact, Ortega et al reported a 61-year-old woman with multiple sclerosis who developed CLIPPERS shortly after natalizumab withdrawal, and the presentation raised concerns of CNS lymphoma which led to a brain biopsy [7]. Symmonds et al reported a 36-yearold woman with initial diagnosis of CLIPPERS developed neuromyelitis optica spectrum disorders with brainstem involvement with anti-myelin-oligodendrocyte glycoprotein antibodies [8].…”

Section: Discussionmentioning

confidence: 99%

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) after treatment for Hodgkin’s lymphoma

et al. 2015

View full text Add to dashboard Cite

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare central nervous system (CNS) disorder with distinct radiological features. However, CLIPPERS may mimic CNS lymphoma, and several cases in which CLIPPERS occurred premonitory to CNS lymphoma have been reported. We report a 31-year-old man presenting with progressive gait ataxia and the characteristic MRI features of CLIPPERS. He was diagnosed with stage II Hodgkin's lymphoma at the age of 15, and we considered the possibility of newly emerged CNS lymphoma occurring in the immunosuppressive condition after the treatment of Hodgkin's lymphoma. Histological findings showed no evidence of CNS lymphoma and the neurological symptoms were resolved by steroids. Although CLIPPERS developed in the reverse order in this case, CLIPPERS should be considered in different diagnosis for CNS lymphoma.

show abstract

CLIPPERS complicating multiple sclerosis causing concerns of CNS lymphoma

Cited by 30 publications

References 6 publications

CLIPPERS With Chronic Small Vessel Damage: More Overlap With Small Vessel Vasculitis?

CLIPPERS With Chronic Small Vessel Damage: More Overlap With Small Vessel Vasculitis?

Horizontal eyeball akinesia as an initial manifestation of CLIPPERS

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) after treatment for Hodgkin’s lymphoma

Contact Info

Product

Resources

About