case_images: PMC11783489_01
case_images: Serial MRI. Initial MRI (a-f), 3 years before current admission reveals multiple T2-hyperintense, punctuate lesions in the pons and the cerebellum on axial T2-FLAIR image (arrows a), enhancing on axial T1 post-contrast administration (arrows b). Sagittal T1 post-contrast images (c-f) show multiple foci of contrast enhancement in the pons, the cerebellum, and the medulla oblongata (arrows c), as well as in the cervical (arrows d), thoracic spinal cord (arrows e) and in the conus medullaris (arrow f). Resolution of the abnormalities following corticosteroid treatment is evident on sagittal T1 post-contrast image 2 months later (g). Six months after the initial MRI a new T2-FLAIR hyperintense area is noticed in the left middle cerebellar peduncle (arrow h), while smaller hyperintense foci appear in the cerebellum and the spinal cord. Axial brail T1 (i) and sagittal cervical spine T1 (j), both post-contrast administration reveal lesion enhancement in the left cerebellar peduncle, the cerebellum (arrows i), and the spinal cord (arrow j). Response to corticosteroids was found on follow-up MRIs (not shown). Finally, MRI 3 years after the initial scan shows a T2-FLAIR hyperintense (arrow k), enhancing (arrow l) mass lesion with increased relative perfusion on cerebral blood volume map (arrow m) in the left cerebellar hemisphere and the ipsilateral cerebellar peduncle. High Cho concentration, decreased NAA, lipid (short arrow n), and lactate (long arrow n) peaks were found on MR spectroscopy (n).. Cho: choline; NAA: N-Acetylaspartate.
case_images: 10.1177_2050313X251316764-fig1.jpg
case_images: PMC11783489_01_10.1177_2050313X251316764-fig1.jpg
case_images: fig1-2050313X251316764
case_images: Three years ago, at the age of 66, the patient's brain and spinal cord MRI revealed multiple T2-hyperintense, enhancing lesions in the posterior cranial fossa and spinal cord (Figure 1(a)-(f)). T lymphocytes: 76.3% CD3(+)CD4(+) and 20.3% CD3(+)CD8(+). The patient received intravenous and per os corticosteroids with clinical and radiological remission and ultimately the diagnosis of probable CLIPPERS was set   (Figure 1(g)). Six months later, a few new punctuate T2-hyperintense enhancing lesions in the cerebellum and cervical spinal cord and a larger lesion in the left cerebellum peduncle appeared (Figure 1(h)-(j)). Brain MRI (Figure 1(k)-(n)) was performed and showed a mass lesion in the left cerebellar hemisphere with peripheral enhancement, perilesional edema, and mass effect on the fourth ventricle.