Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids
Bilateral L>R facial numbness. Jaw jerk brisk ? demyelination ? trigeminal neuropathy
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Multiple small foci of T2/FLAIR hyperintensity and contrast enhancement in the pons and less so in the medulla and cerebellum where they are located at the grey-white junction.
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is characterised by infiltration of the brain by inflammatory cells particularly the pons, with punctate foci of contrast enhancement best seen on MRI. The disorder usually readily responds to immunosuppression with glucocorticosteroids.
This case was confirmed histologically with brain biopsy.