Diffuse white matter alteration in CLIPPERS: Advanced MRI findings from two cases: Journal of the Neurological Sciences

M. Morassi, M. Cobelli, E. Ghiselli, P. Costa, D. Bagatto, M. Pievani, C. Bnà

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Advanced MRI findings in two patients with probable chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) are presented. Diffusion tensor imaging indices (fractional anisotropy and mean diffusivity), evaluated in both patients at baseline MRI examination before treatment and during follow-up, indicated white matter structural changes not only affecting the brainstem, which represents the primary site of inflammatory damage, but also projection (corona radiata) and associative tracts in both patients, while alterations within the corpus callosum were detected in patient 1# at follow-up. Susceptibility weighted imaging (SWI) revealed hypointense lesions in both patients, MRI spectroscopy (MRS) indicated a mildly increased Cho/NAA ratio with no evidence of lipids/lactate peaks, indicating that it may be used as a non-invasive marker to identify CLIPPERS cases suspected for progression to lymphoma. © 2019 Elsevier B.V.
Original languageEnglish
Pages (from-to)40-47
Number of pages8
JournalNeurol. Sci.
Publication statusPublished - 2019


  • Diffusion tensor imaging
  • Hypointense lesions
  • Spectroscopy
  • Susceptibility weighted imaging
  • White matter alterations
  • albumin
  • beta 2 microglobulin
  • bilirubin
  • creatinine
  • ferritin
  • gadoterate meglumine
  • immunoglobulin G
  • methylprednisolone
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  • protein
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  • Article
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  • corpus callosum
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  • pleocytosis
  • priority journal
  • protein blood level
  • steroid therapy
  • susceptibility weighted imaging
  • tendon reflex
  • trigeminal nerve
  • urea blood level
  • white matter


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