Disclosures: Andrew F. McElroy, IV, MD: Nothing to disclose

Case Description: Patient presented with 3 weeks of malaise, fatigue, occipital headache, and facial droop on the left. Patient was first diagnosed with Bell’s Palsy and sent home. As symptoms continued patient developed sensorineural hearing loss, diplopia due to a cranial nerve 6 palsy, and severe ataxia. Lumbar puncture was done which showed elevated protein, low glucose, but was negative for bacterial, viral, and Lyme disease. MRI imaging of demonstrated pontine/cranial nerve inflammation. CLIPPERS was suspected due to symptoms and imaging findings. Patient was started on Solumedrol and IVIG for 5 days, and then prednisone 60mg daily. Patient was transferred to acute rehabilitation for further treatment and recovery.

Setting: Rehabilitation Unit in a Tertiary Hospital

Patient: 36-year-old male with PMH of asthma.

Assessment/Results: With continued rehabilitation and steroids, patient demonstrated a dramatic improvement with his ataxia, diplopia, and hearing loss. Rehabilitation was focused on gait training, balance, and community reentry. Patients FIM improved from 69 upon admission to 109 on discharge. Individually, FIM for toileting went from 1 to 7, transfers 1 to 5, locomotion 1 to 5, and distance walked went from less than 50 feet to greater than 150.

Discussion: CLIPPERS is a central nervous system inflammatory disease defined in 2010 by Pittock and colleagues. Diagnosis includes recurrence of brainstem symptoms, curvilinear enhancing lesions involving the pons on MRI, clinical and radiological response to steroids, and alternative diagnosis ruled out. Signs and symptoms include but not limited to gait ataxia, dysarthria, diplopia, cognitive impairment, deafness, and abnormal facial sensations. Treatment was concentrated on gait training, balance, and community reentry.

Conclusion: CLIPPERS is a rare inflammatory disease of the pons which shows substantial improvement with steroids. This case demonstrated that steroids combined with therapy helped improve overall outcome. Despite patient poor functional level on admission patient was able to go home.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/acute-rehabilitation-of-chronic-lymphocytic-inflammation-with-pontine-perivascular-enhancement-responsive-to-steroids-clippers-a-case-report/