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MS Bladder – ISC Indication — SCE Neurology MCQ

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HardMultiple Sclerosis & CNS InflammationMS Bladder – ISC IndicationSCE Neurology

A 58-year-old develops diplopia, gait ataxia, dysarthria and facial paraesthesia over six weeks. MRI shows numerous punctate and curvilinear enhancing lesions under 3 mm, densely peppering the pons and middle cerebellar peduncles without mass effect. CSF cytology and infection studies are negative. Which diagnosis best fits this pattern?

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Reveal the answer and explanation

Correct answer: E — Probable CLIPPERS syndrome

Explanation lettering: D = shown as B · E = shown as D · B = shown as E

B is correct: CLIPPERS produces a subacute pontocerebellar syndrome with characteristic punctate or curvilinear perivascular enhancement peppering the pons and a marked corticosteroid response. Lymphoma more often forms larger or diffusion-restricting lesions and can transiently respond to steroids, so exclusion and follow-up remain essential. Neurosarcoidosis favours leptomeningeal, hypothalamic or cranial-nerve involvement. Listerial rhombencephalitis is usually acutely systemic, while MOG disease more often causes larger poorly demarcated brainstem lesions.

Reference: CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids: https://pn.bmj.com/content/11/6/349