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| A good day for sun-bathing! |
The first considers the relationship of CLIPPERS to a form of cerebral vasculitis - this was on the list of possible diagnoses I encountered in 2011. Interestingly, this paper (CLIPPERS With Chronic Small Vessel Damage: More Overlap With Small Vessel Vasculitis) is written from the perspective of the neuropathologist and makes the point that to-date there has been perhaps more emphasis on neuroimaging rather than direct examination of tissue. Presumably, this is partly because of the practical challenges of brain biopsy in the regions typically affected in CLIPPERS. The key finding in their described CLIPPERS case is that "small vessel injury" could be seen despite vasculitis not forming part of the original disease description. They do concede that vasculitis might not be the root cause of the observed vessel damage but carefully consider the evidence for this and other causes.
The second paper, Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an Immune-Competent Patient, considers a case initially thought to be CLIPPERS but, after failing to respond to steroids, subsequently found to be lymphoma. I have to say, that the contrast-enhanced imaging in this case, particularly figure 1c, does not look quite the same as similar images of other CLIPPERS patients I have seen but .... I am not a doctor. The whole issue of the relationship of CLIPPERS to CNS lymphoma is vital to resolve. It is not clear to me whether it is simply a diagnostic issue or whether, as some have suggested, there may be a biological relationship between the two conditions.
The second paper, Diffusely Infiltrating Central Nervous System Lymphoma Involving the Brainstem in an Immune-Competent Patient, considers a case initially thought to be CLIPPERS but, after failing to respond to steroids, subsequently found to be lymphoma. I have to say, that the contrast-enhanced imaging in this case, particularly figure 1c, does not look quite the same as similar images of other CLIPPERS patients I have seen but .... I am not a doctor. The whole issue of the relationship of CLIPPERS to CNS lymphoma is vital to resolve. It is not clear to me whether it is simply a diagnostic issue or whether, as some have suggested, there may be a biological relationship between the two conditions.
Read other articles in this series at Living With CLIPPERS.
Living With CLIPPERS by Bill Crum is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License.
