Diagnosing CLIPPERS Using MRI is Tricky

Spring is in the air, as evidenced by this recent visitor who has successfully found a way through the garden fence and is getting bigger.

Contrast-enhanced MRI of my brain in 2011.
The bright spots in the middle indicate CLIPPERS-related damage.

One of the hallmarks of CLIPPERS is the characteristic pattern of enhancing lesions many of you will have seen in MRI. It is tempting to regard the presence of a pattern like this as sufficient evidence to diagnose CLIPPERS, particularly when there is no clear alternative. Unfortunately, life is rarely that simple and there may be other reasons why patterns of lesions like this can develop.

Dr Taieb and colleagues have helpfully written a guide to diagnosis in these cases. Their paper, Punctate and curvilinear gadolinium enhancing lesions in the brain: a practical approach, examines 39 cases of their own where similar patterns of brain lesions occur, together with other reported cases, and details the many different problems which could be the cause. (Unfortunately, this paper isn't freely available to read from Springer - you can try asking Dr Taieb for a pre-print.)

This (above) is perhaps the most interesting part, a diagnostic flow-chart for when lesions are present. Interestingly Dr Taieb suggests brain-biopsy only as a last resort. Fitting CLIPPERS into a standard diagnostic process is clearly important. This paper may not be the last word on the subject but is a step in the right direction.

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.

International Rescue

George

Genetic and Rare Diseases Information Center (GARD)

Well this blog has passed the quality checks for resources linked to by GARD and is now listed here (under the Organizations tab). This might explain the slightly increased traffic I've seen here recently although Mark Zuckerberg still has nothing to lose sleep over. Still, if there is anyone out there with a probable/presumptive/possible CLIPPERS diagnosis who wants to share a bit of their story (anonymously if you like)  let me know (see the FAQ) and I'll start a summary page.

Prodding and Poking

Another couple of days of prodding and poking booked in for next week at the NHNN. As far as I know this is comfy chair,  "Brain MRI" and "Case Review", and no-doubt a bit of walking in a straight line and tracking various things being waved in front of my eyes. Also no doubt a medication review which could be important as on the current schedule I'll be off cortico-steroids completely in 6 weeks.

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.

Once More Unto the Breach, Dear Friends

Six months ago I first got symptoms of what I now know is probably CLIPPERS. This week it's time for two days of reassessment, fortunately as an out-patient this time. This also coincides with the last few days of my reducing steroid course which so far has done it's job and kept CLIPPERS at bay.  So with the benefit of hindsight, time for a brief recap of the last few months.

Aside on Hospital Life

And now a brief aside from the world of CLIPPERS for some reflections on hospital life. Although I've worked in and around hospitals for much of my career I had never before been admitted to one as a patient. So all of a sudden I found myself as an in-patient for several days of unspecified tests and facing an uncertain outcome. So how did I feel? Bloody marvellous as it turned out.