Fitting SLIPPERS with imaging, histopathology and treatment response

Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids is a clinical entity identified within the past decade. Highlighted in only a few case reports since then, our patient presentation adds to the scarce literature on this immune-mediated process. A woman in her early 60s developed worsening right-sided facial pain and diffuse headache for 2 weeks, subsequently demonstrating left upper extremity weakness. She also underwent recent endoscopic sinus surgery ahead of symptom onset. Her MRI brain scans revealed supratentorial areas of bilateral nodular enhancement. Lumbar puncture had shown lymphocytic pleocytosis and elevated protein. This case reviews differential diagnosis considerations and the subsequent therapeutic approach. Clinical, radiographic and histopathological findings ultimately supported a perivascular inflammatory process. She responded clinically and radiographically to a course of corticosteroids, further reinforcing her presenting diagnosis.