CLIPPERS-like MRI findings in a patient with multiple sclerosis

Ferreira, Rafael Martins; Machado, Gabriela; Souza, Anderson Santos; Lin, Kátia; Correa-Neto, Ylmar

doi:10.1016/j.jns.2013.01.032

Cited by 35 publications

(18 citation statements)

References 7 publications

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“…Relevant differential diagnoses of CLIPPERS are depicted in Table and include neurosarcoidosis, neuro‐Behçet's disease, Sjögren's syndrome, inflammatory demyelinating CNS diseases such as multiple sclerosis (MS) and acute disseminated encephalomyelitis (ADEM), neuromyelitis optica (NMO), Bickerstaff brainstem encephalitis and other autoimmune encephalitides, CNS vasculitides, including PACNS, CNS infections, CNS histiocytosis, lymphomatoid granulomatosis, CNS lymphoma, glioma and paraneoplastic disorders . The following sections summarize the auxiliary diagnostic procedures and findings in hitherto reported cases, accomplished to complete the essential clinical and MRI examinations.…”

Section: Diagnosismentioning

confidence: 99%

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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

Dudešek

Rimmele

Tesar

et al. 2014

Clinical and Experimental Immunology

140

181

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OTHER ARTICLES PUBLISHED IN THIS SERIESParaneoplastic neurological syndromes. Clinical and Experimental Immunology 2014, 175: 336-48. Diagnosis, pathogenesis and treatment of myositis: recent advances. Clinical and Experimental Immunology 2014, 175: 349-58. Disease-modifying therapy in multiple sclerosis and chronic inflammatory demyelinating polyradiculoneuropathy: common and divergent current and future strategies. Clinical and Experimental Immunology 2014, 175: 359-72. Monoclonal antibodies in treatment of multiple sclerosis. Clinical and Experimental Immunology 2014, 175: 373-84

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Section: Diagnosismentioning

confidence: 99%

“…, Ferreira et al . , Buttmann et al . ), several presumptive cases of CLIPPERS were reported, in which other discrete diseases were finally diagnosed (Limousin et al .…”

Section: Introductionmentioning

confidence: 99%

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

Dudešek

Rimmele

Tesar

et al. 2014

Clinical and Experimental Immunology

140

181

View full text Add to dashboard Cite

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“…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

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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.

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“…[2][3][4] The Symmonds et al case highlights a possible pathophysiologic connection between CLIPPERS and demyelinating diseases. Except for glioma, all of these diseases initially respond to high doses of steroids, and some could have a relapsing-remitting course in absence of immunosuppressive therapy.…”

mentioning

confidence: 95%

Anti-MOG antibodies with longitudinally extensive transverse myelitis preceded by CLIPPERS

et al. 2015

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1. Chowdhury FA, Pawley AD, Ceronie B, et al. Motor evoked potential polyphasia: a novel endophenotype of idiopathic generalized epilepsy. Neurology 2015;84:1-7. 2. Di Lazzaro V, Restuccia D, Oliviero A, et al. Effects of voluntary contraction on descending volleys evoked by transcranial magnetic stimulation in conscious humans. J Physiol 1998;508:625-633. 3. Hess CW, Mills KR, Murray NM Responses in small hand muscles from magnetic stimulation of the human brain.

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CLIPPERS-like MRI findings in a patient with multiple sclerosis

Cited by 35 publications

References 7 publications

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

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

Horizontal eyeball akinesia as an initial manifestation of CLIPPERS

Anti-MOG antibodies with longitudinally extensive transverse myelitis preceded by CLIPPERS

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