CLIPPERS With Exclusive Extra Pontine Involvement (original) (raw)

2021, Neurology® Neuroimmunology & Neuroinflammation

Brain MRI revealed subcortical and periventricular white matter lesions in the right frontoparietal and insular lobes, with a perivascular punctate and curvilinear enhancement, with no restricted diffusion, associated with edema without significative mass effect (figure 1). MRI angiography, including vessel wall sequences, did not show vascular stenosis or signs of vasculitis. CSF analysis showed slightly elevated protein levels (49 mg/dL) and cytology with 5 white blood cells; there were no oligoclonal bands, and protein electrophoresis was normal. Infectious screening of CSF was negative for herpes simplex virus I/II, Cytomegalovirus, Adenovirus, Mycobacterium tuberculosis, Varicella zoster virus, human herpesvirus 6/7, and Enterovirus. In addition, neoplastic cells were not detected in CSF. The investigation was also negative for Treponema pallidum, HIV, and hepatitis B and C. The screening for systemic autoimmunity and neoplastic diseases, including FDG PET-CT, was unremarkable.