CLIPPERS: investigations
Written and reviewed by Dr Ibrahim Imam, Consultant Neurologist. Last reviewed .
CLIPPERS: investigations. There are pontine predominant perivascular lesions. The lesions are <3mm in size. Fully referenced neurology checklist.
Magnetic resonance imaging (MRI): pontine features
- There are pontine predominant perivascular lesions
- The lesions are <3mm in size
- They may extend to the cerebellum and the rest of the brainstem
- They show symmetrical homogenous ‘salt and pepper’ curvilinear enhancement
- They may show nodular enhancement
- There is no mass effect
- The lesions may be exclusively extrapontine
Magnetic resonance imaging (MRI): other features
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Cerebrospinal fluid (CSF) analysis
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Blood tests
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Autoimmune screen
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Other investigations
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Acronym
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References
- Tobin WO, Guo Y, Krecke KN, et al. Diagnostic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). Brain 2017; 140:2415-2425.
- Taieb G, Mulero P, Psimaras D, et al; in cooperation with the French CLIPPERS group. CLIPPERS and its mimics: evaluation of new criteria for the diagnosis of CLIPPERS. JNNP 2019; pii: jnnp-2018-318957 (Epub ahead of print).
- Picarelli H, Yamaki VN, Casal YR, et al. CLIPPERS with exclusive extra pontine involvement. Neurol Neuroimmunol Neuroinflamm 2021; 8:e989.
- Blaabjerg M, Ruprecht K, Sinnecker T, et al. Widespread inflammation in CLIPPERS syndrome indicated by autopsy and ultra-high-field 7T MRI. Neurol Neuroimmunol Neuroinflamm 2016; 3:e226.
- Morassi M, Cobelli M, Ghiselli E, et al. Diffuse white matter alteration in CLIPPERS: advanced MRI findings from two cases. J Neurol Sci 2019; 402:40-47.
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