{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T01:36:05Z","timestamp":1787016965543,"version":"build-2736575974"},"reference-count":10,"publisher":"BMJ","issue":"9","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,8,21]]},"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:p>Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a brainstem syndrome marked by punctate \u2018pepper-and-salt\u2019 enhancement on MRI and corticosteroid responsiveness. Evidence suggests that CLIPPERS may represent a cancer-related immune reaction, occurring before tumour detection, in association with active malignancy or after treatment. We report the first case associated with papillary thyroid carcinoma (PTC). A middle-aged woman developed facial numbness and ataxia; MRI showed pontocerebellar enhancement, and work-up revealed PTC. Neurological signs resolved after total thyroidectomy. Sixteen months later, neurological symptoms recurred. Repeat MRI reproduced the CLIPPERS pattern. High-dose intravenous methylprednisolone followed by a short taper induced rapid and sustained clinical and radiological remission. Serial neck ultrasound and serum thyroglobulin measurements confirmed no evidence of PTC recurrence. This case illustrates that CLIPPERS can precede, remit after and recur independently of cancer activity, highlighting the importance of comprehensive malignancy screening and long-term oncological surveillance.<\/jats:p>","DOI":"10.1136\/bcr-2025-267888","type":"journal-article","created":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T13:00:11Z","timestamp":1756990811000},"page":"e267888","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["CLIPPERS syndrome following papillary thyroid carcinoma"],"prefix":"10.1136","volume":"18","author":[{"given":"Giorgi","family":"Mamardashvili","sequence":"first","affiliation":[{"name":"Department of Neurology, Tbilisi State Medical University, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nazibrola","family":"Botchorishvili","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurology, Tbilisi State Medical University, Tbilisi, Georgia"},{"name":"Department of Neurology, Simon Khechinashvili University Hospital, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irma","family":"Berishvili","sequence":"additional","affiliation":[{"name":"Department of Radiology, Simon Khechinashvili University Hospital, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nino","family":"Mikava","sequence":"additional","affiliation":[{"name":"Department of Neurology, Simon Khechinashvili University Hospital, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marina","family":"Janelidze","sequence":"additional","affiliation":[{"name":"Department of Clinical Neurology, Tbilisi State Medical University, Tbilisi, Georgia"},{"name":"Department of Neurology, Simon Khechinashvili University Hospital, Tbilisi, Georgia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,9,4]]},"reference":[{"key":"2025090406000805000_18.9.e267888.1","doi-asserted-by":"crossref","first-page":"2626","DOI":"10.1093\/brain\/awq164","article-title":"Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)","volume":"133","author":"Pittock","year":"2010","journal-title":"Brain (Bacau)"},{"key":"2025090406000805000_18.9.e267888.2","doi-asserted-by":"crossref","first-page":"2415","DOI":"10.1093\/brain\/awx200","article-title":"Diagnostic criteria for chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS)","volume":"140","author":"Tobin","year":"2017","journal-title":"Brain (Bacau)"},{"key":"2025090406000805000_18.9.e267888.3","doi-asserted-by":"publisher","DOI":"10.1136\/jnnp-2018-318957"},{"key":"2025090406000805000_18.9.e267888.4","doi-asserted-by":"crossref","DOI":"10.1177\/17562864211062821","article-title":"Brain biopsy in patients with CLIPPERS syndrome: why and when","volume":"15","author":"Galazky","year":"2022","journal-title":"Ther Adv Neurol Disord"},{"key":"2025090406000805000_18.9.e267888.5","doi-asserted-by":"publisher","DOI":"10.1016\/s1474-4422(22)00431-8"},{"key":"2025090406000805000_18.9.e267888.6","doi-asserted-by":"crossref","first-page":"385","DOI":"10.1111\/cei.12204","article-title":"CLIPPERS: chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids. Review of an increasingly recognized entity within the spectrum of inflammatory central nervous system disorders","volume":"175","author":"Dudesek","year":"2014","journal-title":"Clin Exp Immunol"},{"key":"2025090406000805000_18.9.e267888.7","doi-asserted-by":"crossref","first-page":"224","DOI":"10.1016\/j.jns.2014.06.015","article-title":"A central nervous system B-cell lymphoma arising two years after initial diagnosis of CLIPPERS","volume":"344","author":"Taieb","year":"2014","journal-title":"J Neurol Sci"},{"key":"2025090406000805000_18.9.e267888.8","doi-asserted-by":"crossref","unstructured":"Sanapala C , Diaz M , Wesley S . The Spectrum of Paraneoplastic CLIPPERS (P6-8.006). Neurology (ECronicon) 2025;104. doi:10.1212\/WNL.0000000000210668","DOI":"10.1212\/WNL.0000000000210668"},{"key":"2025090406000805000_18.9.e267888.9","doi-asserted-by":"crossref","DOI":"10.1186\/s12883-021-02135-6","article-title":"Parotid carcinoma following chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids: a case report","volume":"21","author":"Deng","year":"2021","journal-title":"BMC Neurol"},{"key":"2025090406000805000_18.9.e267888.10","doi-asserted-by":"publisher","DOI":"10.1089\/thy.2015.0020"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-267888","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,9,4]],"date-time":"2025-09-04T13:00:12Z","timestamp":1756990812000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-267888"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,9]]},"references-count":10,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2025,9,4]]},"published-print":{"date-parts":[[2025,9]]}},"alternative-id":["10.1136\/bcr-2025-267888"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-267888","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,9]]}}}