PMC10018422_01
The clinical course of the patient. Day 0 indicates the first hospitalization day, when initial brain MRI was performed. IVMP, intravenous methylprednisolone; IVIg, intravenous immunoglobulins.
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F1
The patient's clinical course is summarized in Figure 1.
Brain magnetic resonance imaging (MRI) in a patient with chronic lymphocytic inflammation and pontine perivascular enhancement responsive to steroids (CLIPPERS). a, b Initial brain MRI axial fluid-attenuated inversion recovery (FLAIR) images show symmetric hyperintense areas, mainly in the midbrain, pons, basal ganglia, medulla oblongata, and superior and middle cerebellar peduncles. Swelling of the hyperintense areas and punctate dispersal lesions, which are characteristic of CLIPPERS, are not evident. c Initial brain MRI axial gadolinium-enhancing T1-weighted images show strong gadolinium enhancement in the pons. d, e Brain MRI axial FLAIR images taken after intravenous methylprednisolone (IVMP) treatment show significant improvement in the hyperintense areas and swelling in the brainstem. f Brain MRI axial gadolinium-enhancing T1-weighted images taken after IVMP treatment show improvement in the irregular gadolinium enhancement.
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Brain MRI on day 0 revealed a hyperintense area around the brainstem that included the cerebellar peduncles and cerebellum (Fig. 2a-c). The imaging findings were also improved by IVMP (Fig. 2d, e).