Findings
- Numerous T2/FLAIR hyperintense lesions involving the infratentorial greater than supratentorial brain, with the majority of lesions concentrated in the cerebellum and pons
- Many of these lesions demonstrate associated stippled enhancement
- Areas of encephalomalacia in the right cerebellar hemisphere and right parietal lobe likely correlating with prior biopsy sites
- No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus
- Mild mucosal thickening of bilateral ethmoid air cells without fluid levels
Diagnosis
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)
Sample Report
Numerous T2/FLAIR hyperintense lesions involving the infratentorial greater than supratentorial brain, with the majority of lesions concentrated in the cerebellum and pons and associated stippled, perivascular enhancement. Given the reported history of relapsing symptoms and prior biopsies showing inflammation, chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a primary differential consideration, though other autoimmune disorders, vasculitis, primary CNS lymphoma, and granulomatous disease could have a similar imaging appearance.
No evidence of acute infarct, hemorrhage, mass effect, or hydrocephalus.
Discussion