Clippers: A Case which does not Respond to Steroid Treatment

Inthisstudy, we aimed to increase our knowledge by comparing clinical and brain magnetic resonance imaging (MRI) findings in CLIPPERS syndrome.A 34-year-old male patient was treated with a diagnosis of upper respiratory tract infections at centers where he had begun slowly with no previous history of illness and drug use, and had complaints of exacerbation, vomiting, anorexia and unbalanced gait. But the clinical features were not stable, visual impairment, speech slowing, swallowing and chewingdifficulties were added, neurological evaluation was performed, and high-dose pulse methylprednisolonetherapy following brain MR was administered 1 g/day intravenously for five days.Oral methylprednisolone treatment was continued. Corticotherapy was partially responded and the patient had an aspirationpneumonia after three months and died at the fourth month of the illness. 1.5 tesla brain MRI was performed and T1w,T2w,T2 flair and diffuse axial sections were taken. Cerebrospinal fluid analysis was performed.Brain MRI revealed diffuse hyperintense lesions at the level of pons and bilateral cerebellarhemispheres. There were slightly contrast enhancement. In the deep gray matter nuclei (basalgangliaandthalamus) and periventricular and subcortical there were also extensive punctate lesions observed in the fields.Brain MRI features were found to be compatible with CLIPPERS. Multiple sclerosis and other demyelinating diseases should be considered in differential diagnosis. But it was questioned whether or not the patient was responding to the steroid, and he was held responsible fort the late treatment. Early recognition may be a critical factor in stopping the deterioration of the clinic and positively affecting prognosis.