Contributions
Abstract: EP1301
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: In 2010 was described by Pittock et al. an inflammatory syndrome with subacute clinical signs of pontine lesion, in relapses, responsive to corticosteroid therapy but not to all immunosuppressants, called Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids - CLIPPERS. After the first report, several cases appeared showing more extensive attacks involving other central nervous system areas such as midbrain, medulla, spinal cord and subcortical white matter.
Objective: Report a clinical case of a young man with recurrent myelitis responsive to corticosteroid and CLIPPERS imaging.
Case description: A 20-year-old black male with a history of recurrent lower limb weakness and urinary incontinence. He had the first myelitis at age 13, when he began to walk with assistance after a week. At the time he was admitted at the hospital and received corticosteroid therapy with complete recovery. He had a new event at age 16 with paraparesis and got restricted to wheelchair, with urinary incontinence, that partially responded to pulse therapy. After another 2 episodes, was started Mycophenolate Mofetil as maintenance therapy, but nevertheless he had another 6 incidents within 2 years when they decided to switch for Interferon 1A. He continued with frequent relapses but recently with upper limbs weakness, which was not noted before. He had another myelitis in November / 2017 with extensive laboratory and radiological investigation without diagnostic conclusion. His magnetic resonance imaging (MRI) of brain and spinal cord showed multiple lesions, of 1-2 mm, with increased signal in Fluid attenuation inversion recovery (FLAIR) at the pons and spinal cord, with contrast enhancement. After case review, was suggested diagnosis of CLIPPERS base on imaging features, despite the atypical clinical presentation. Prednisone was started at 1mg / kg / day dosage with partial response and he currently walks with the aid of crutches.
Conclusion: CLIPPERS is a rare syndrome recently reported that should be considered when there is suggestive neurologic features and typical imaging, excluding other causes. This case describes an atypical clinical presentation without brainstem symptoms or signs, with typical imaging of the syndrome, rarely documented on literature.
Disclosure: Fernandez KD: nothing to disclose; Schmidt FR: nothing to disclose; Goes CPQF: nothing to disclose
Abstract: EP1301
Type: Poster Sessions
Abstract Category: Clinical aspects of MS - Diagnosis and differential diagnosis
Introduction: In 2010 was described by Pittock et al. an inflammatory syndrome with subacute clinical signs of pontine lesion, in relapses, responsive to corticosteroid therapy but not to all immunosuppressants, called Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids - CLIPPERS. After the first report, several cases appeared showing more extensive attacks involving other central nervous system areas such as midbrain, medulla, spinal cord and subcortical white matter.
Objective: Report a clinical case of a young man with recurrent myelitis responsive to corticosteroid and CLIPPERS imaging.
Case description: A 20-year-old black male with a history of recurrent lower limb weakness and urinary incontinence. He had the first myelitis at age 13, when he began to walk with assistance after a week. At the time he was admitted at the hospital and received corticosteroid therapy with complete recovery. He had a new event at age 16 with paraparesis and got restricted to wheelchair, with urinary incontinence, that partially responded to pulse therapy. After another 2 episodes, was started Mycophenolate Mofetil as maintenance therapy, but nevertheless he had another 6 incidents within 2 years when they decided to switch for Interferon 1A. He continued with frequent relapses but recently with upper limbs weakness, which was not noted before. He had another myelitis in November / 2017 with extensive laboratory and radiological investigation without diagnostic conclusion. His magnetic resonance imaging (MRI) of brain and spinal cord showed multiple lesions, of 1-2 mm, with increased signal in Fluid attenuation inversion recovery (FLAIR) at the pons and spinal cord, with contrast enhancement. After case review, was suggested diagnosis of CLIPPERS base on imaging features, despite the atypical clinical presentation. Prednisone was started at 1mg / kg / day dosage with partial response and he currently walks with the aid of crutches.
Conclusion: CLIPPERS is a rare syndrome recently reported that should be considered when there is suggestive neurologic features and typical imaging, excluding other causes. This case describes an atypical clinical presentation without brainstem symptoms or signs, with typical imaging of the syndrome, rarely documented on literature.
Disclosure: Fernandez KD: nothing to disclose; Schmidt FR: nothing to disclose; Goes CPQF: nothing to disclose