A new case of chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids

Sir, We read with great interest the recent article published in Brain by Pittock and colleagues (2010) describing eight patients with a previously unrecognized distinct brainstem encephalitis named chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS). Here, we report on what we believe to be another patient with CLIPPERS, lending further support to the concept that CLIPPERS is a novel, definable, inflammatory CNS disease. The patient provided written informed consent for presentation of her case as a report. A 69-year-old female noticed general weakness, dizziness and abnormal fatigue with subacute onset 16 weeks prior to evaluation at the Department of Neurology, Charite, Universitatsmedizin, Berlin. Eleven weeks prior, the patient developed horizontal diplopia and walking difficulties that gradually worsened so that she became unable to walk without assistance. Additionally, she noticed dysarthria and dysphagia as well as facial tingling and paraesthesia in her fingertips. About 4 weeks prior to admission, she developed hyperacusis and a labile affect with involuntary crying. Her past medical history was unremarkable except for arterial hypertension, which was treated with bisoprolol. Her family history was negative. Neurological examination on admission revealed a cerebellar syndrome with limb, gait and stance ataxia, as well as intention tremor on the left, more than on the right-hand side. She had marked cerebellar dysarthria. Her gait …