MRI of CLIPPERS - And Now the Science Bit

CLIPPERS results in lesions with a characteristic appearance, both in terms of where they are and what they look like, on brain MRI. Pittock et al describe them as "a characteristic pattern of punctuate and curvilinear enhancement peppering the pons and extending variably into the medulla, brachim pontis and mid-brain". The lesions are thought to result from some underlying inflammatory process which has yet to be identified. The exact number and location of lesions is different amongst different patients, presumably contributing to the variability in symptoms seen.

To BB Or Not To BB ...

... That Is The Question

During the investigations which resulted in my current diagnosis of "presumptive CLIPPERS" I declined a brain biopsy (BB) (the surgical removal of a brain-tissue sample for laboratory investigation). Here's why.

Life in the Slow Lane

I walk fast, I always have done. In part it's a physical thing as being tall means I need fewer steps to get somewhere than many other folk (I have a higher cadence).  On the other hand natural impatience also plays a part. I don't like to dawdle; I'm a rush-hour train-commuter on a schedule who doesn't like delay. Suffering coordination and balance disorders which impact on walking offers a unique and unwelcome insight into life in the slow lane. Maybe it's payback time for years of commuting intolerance.

If not CLIPPERS then what?

Regular readers will know that a CLIPPERS diagnosis is neither quick nor simple. A large part of the process is excluding other conditions with similar or overlapping symptoms because it is vital that treatment fits the diagnosis as far as possible. Some of these conditions are more amenable to diagnosis than CLIPPERS because they are more common and better understood. The remainder are conditions about which less is known because of their rarity making differential diagnosis even harder. Here are the conditions I have found mentioned in the research literature which have been considered before diagnosing CLIPPERS. I bet that like me, most of you haven't heard of many of these. There are a frightening number of obscure and less obscure things which can go wrong with the old grey (and white) matter. As always please treat my interpretations of these complex disorders with caution and always go to authoritative sources for more information.