Tuesday 11 February 2014

A Spanish Case of CLIPPERS

A recent fatal BSOD encountered in my day-job.
I've been holding off discussing this case (CLIPPERS syndrome with atypical distribution of lesions in magnetic resonance imaging of the brain) in the hope I could get hold of the full text - unfortunately I couldn't. Anyhow, these single cases, while interesting, are not always that insightful as these days they have to be atypical (or at least notably different in some way from "classic" CLIPPERS)  to be published. 

What I mean is that, they may be interesting to the specialist, but by throwing in an unusual presentation of symptoms or comorbidities, they can "muddy the waters" (in my view at least) as to what CLIPPERS really is. On the other hand, you could argue that I don't know what I'm talking about (and you'd be right!) and that CLIPPERS could be a broad-spectrum disorder that is still being mapped out by these case studies.

I only got to read the summary of this paper, but the gist seems to be that a 40 year old woman presented with some of the better-known CLIPPERS symptoms (diplopia, ataxia, disarthria) but a non-standard appearance of brain lesions in MRI. The lesions seemed to be in the standard places but more evenly distributed (?) (with the proviso that I'm not 100% certain what "enhancement gradient" means in this context); the authors imply the lesion density remains more constant in different parts of the brain than is typical. The response to treatment with steroids seems to be as expected for CLIPPERS.

So at least there are still papers coming through and things to be learned about CLIPPERS.

Read other articles in this series at Living With CLIPPERS.

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