CLIPPERS-like MRI findings in a patient with multiple sclerosis

Area of Science:

• Neuroimmunology
• Neuroradiology
• Inflammatory Neurological Diseases

Background:

• Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a distinct pontine-predominant encephalomyelitis.
• CLIPPERS typically shows a favorable response to corticosteroids and often requires long-term immunosuppression.
• Characteristic brain MRI findings include punctate and curvilinear enhancement lesions in the pons.

Observation:

• This report describes a patient with a confirmed diagnosis of relapsing-remitting multiple sclerosis (MS).
• The patient presented with brain magnetic resonance imaging (MRI) findings that mimicked the classic presentation of CLIPPERS.
• The observed imaging pattern included pontine enhancement lesions consistent with CLIPPERS.

Findings:

• The study identifies a potential overlap in imaging findings between CLIPPERS and relapsing-remitting multiple sclerosis (MS).
• Pontine perivascular enhancement, a hallmark of CLIPPERS, was observed in an MS patient.
• This suggests that MS may present with imaging characteristics previously considered unique to CLIPPERS.

Implications:

• The findings challenge the distinctiveness of CLIPPERS based solely on imaging characteristics.
• It highlights the importance of considering multiple sclerosis in the differential diagnosis of CLIPPERS-like lesions.
• This may lead to revised diagnostic criteria and improved patient management strategies for both conditions.