Thursday, 14 March 2013

Another Case

In a recent abstract from a conference program, published in the Journal of Investigative Medicine (vol. 61, no.2, Feb. 2013), a new case of CLIPPERS in the USA is described. This case is slightly more "classic" CLIPPERS than some of the more recent reported cases. Essentially a 52 year old woman suffered from left-sided weakness and gait ataxis which progressed to diplopia, disarthria and right-sided facial numbness. The doctors were initially stuck between possible diagnoses of CNS lymphoma, neurosarcoidosis and inflammatory disease (including CLIPPERS). These were also considered for me along the way and are all difficult to diagnose. This patient had a good response to treatment with corticosteroids and Azathioprine, although the authors noted that other non-CLIPPERS pathology also seemed to be present.

The authors suggest that patients with CLIPPERS-like signs can be treated for CLIPPERS without brain-biopsy. This point still seems controversial - there are a growing number of patients (including me) who have been treated without brain-biopsy to confirm the "Lymphocytic Inflammation" part of CLIPPERS. However, even with successful treatment, there remains diagnostic uncertainty without physical examination of brain tissue. Currently the diagnostic and treatment decisions have to be made carefully on a case by case basis.

Read other articles in this series at Living With CLIPPERS.

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