Role of advanced MRI in diagnosing and evolutive follow-up to treatment in a case of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a rare inflammatory disorder that affects the brainstem and cerebellum. Patients often show symptoms like ataxia, diplopia, and dysarthria. Diagnosis can be complex due to the need to exclude other conditions. We present a case of a 35-year-old previously healthy female admitted to our hospital with dizziness, progressively worsening gait, and mild dysarthria. Advanced MRI techniques revealed characteristic lesions in the pons and cerebellum with characteristic "peppering" appearance, supporting a diagnosis of CLIPPERS. The patient improved significantly with corticosteroid treatment, emphasizing the importance of early recognition and treatment. Follow-up MRIs demonstrated a reduction in lesions, reinforcing the effectiveness of corticosteroids. The etiology of CLIPPERS remains unclear, but it is believed to involve immune-mediated mechanisms. Regular monitoring and long-term treatment strategies are essential to manage this condition effectively. This case underscores the critical need for increased awareness of CLIPPERS among clinicians and radiologists. It also highlights the importance of integrating clinical, radiological, and neuropathological findings for accurate diagnosis. Given its rarity and diagnostic complexity, this case report provides valuable pathogenetic insights into a poorly understood condition.