PMC6556810_01
Post-gadolinium axial and sagittal T1w images at different representative levels, performed at diagnosis.. MRI examination showed punctate symmetrical contrast-enhancement within basal ganglia and pons, extending to adjacent midbrain and middle cerebellar peduncles, as well as to the medial aspects of cerebellar hemispheres.
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T1w revealed several punctate foci of enhancement with perivascular pattern, almost symmetrical, involving the pons and extending to adjacent midbrain and medial aspects of middle cerebellar peduncles; some sporadic foci of enhancement were also detectable within the cerebellar hemispheres and basal ganglia (Fig. 1). There was no evidence of leptomeningeal enhancement, and the spinal cord was normal.
Post-gadolinium axial and sagittal T1w images at the same levels 1 week after the beginning of corticosteroid therapy.. MRI examination revealed a reduction in number and size of contrast-enhancement foci within basal ganglia and midbrain, with a complete regression of enhancing nodules in cerebellar hemispheres and pedicles.
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T2w hyperintense areas of the midbrain with a simultaneous decrease of the punctate foci of contrast enhancement on T1w images, more evident in the cerebellar hemispheres (Fig. 2). This parallel clinical and radiological evolution, depending on the effective treatment with corticosteroids, confirmed ex juvantibus the diagnosis of CLIPPERS.