Wall Rosemary J
Countess of Chester Hospital, UK.
J Intensive Care Soc. 2018 May;19(2):167-170. doi: 10.1177/1751143717719644. Epub 2017 Jul 17.
Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) has been described in multiple case reports since it was first described in the literature in 2010. The patient described is a 54-year-old man with no significant medical history who presented with ataxia, diplopia and hearing and taste disturbances. His GCS reduced to the point at which he required intubation and he was treated for 50 days on an intensive care unit. The patient's course also includes seizures, first described in 2014, and central pyrexia, which has not been previously described in case reports of CLIPPERS. Intravenous methylprednisolone resulted in a rapid and significant recovery; neurological rehabilitation is ongoing 10 months from diagnosis. The importance of recognition of unusual radiological findings and rapid treatment cannot be overemphasised in improving patient's long-term outcomes.
自2010年首次在文献中被描述以来,多例报告中均提及了对类固醇有反应的桥脑周围血管强化慢性淋巴细胞性炎症(CLIPPERS)。所描述的患者为一名54岁男性,既往无重大病史,表现为共济失调、复视以及听力和味觉障碍。其格拉斯哥昏迷评分降至需要插管的程度,并在重症监护病房接受了50天的治疗。患者病程还包括2014年首次出现的癫痫发作以及中枢性发热,而中枢性发热在CLIPPERS的病例报告中此前尚未有过描述。静脉注射甲泼尼龙后患者迅速且显著康复;自诊断起10个月后神经康复仍在进行。在改善患者长期预后方面,认识到不寻常的影像学表现并迅速治疗的重要性再怎么强调也不为过。