{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T03:44:35Z","timestamp":1786506275466,"version":"build-2736575974"},"reference-count":16,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T00:00:00Z","timestamp":1691712000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Brain Sciences"],"abstract":"<jats:p>Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids (SLIPPERS) is a rare variant of the CLIPPERS spectrum with less than ten reports published so far. There is ongoing discussion regarding whether SLIPPERS is a disease entity on its own or just an acronym encompassing many underlying diagnoses, such as sarcoidosis, vasculitis and anti-glial fibrillary acidic protein (GFAP)-associated disease. A 40-year-old woman presented with episodes of language and attention impairment. Magnetic resonance imaging (MRI) revealed T2\/FLAIR hyperintense lesions in the subcortical white matter associated with a micronodular, curvilinear perivascular contrast-enhancement. Alternative diagnoses were excluded. There was a remarkable response to steroids. A relapse occurred after six years, and the biopsy showed perivascular T-cell lymphocytic infiltrate, without granulomas, vasculitis, or neoplasia. There was complete resolution of the relapse after steroids. This case represents the longest reported follow-up of a patient diagnosed with SLIPPERS, and brain biopsy after 6 years did not suggest alternative diagnoses. This report contributes to the discussion regarding the possibility that exclusive supratentorial CLIPPERS-like pathology might be an isolated disease entity, but more biopsy-proven cases with a longer follow-up are needed to support this hypothesis. Recently, GFAP astrocytopathy has been characterized and might correspond to a significant number of cases previously diagnosed as CLIPPERS or SLIPPERS.<\/jats:p>","DOI":"10.3390\/brainsci13081191","type":"journal-article","created":{"date-parts":[[2023,8,11]],"date-time":"2023-08-11T10:20:16Z","timestamp":1691749216000},"page":"1191","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids (SLIPPERS)\u2014Does it Really Exist?"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9378-2539","authenticated-orcid":false,"given":"Fernando","family":"Freua","sequence":"first","affiliation":[{"name":"Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo 01323-001, Brazil"},{"name":"Clinics Hospital, Faculty of Medicine, University of Sao Paulo, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0700-3517","authenticated-orcid":false,"given":"Jo\u00e3o Vitor","family":"Mahler","sequence":"additional","affiliation":[{"name":"Clinics Hospital, Faculty of Medicine, University of Sao Paulo, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8517-2324","authenticated-orcid":false,"given":"Pedro Lucas Grangeiro de S\u00e1 Barreto","family":"Lima","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, Federal University of Ceara, Fortaleza 60430-160, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8561-9069","authenticated-orcid":false,"given":"Iuri Santana","family":"Neville","sequence":"additional","affiliation":[{"name":"Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo 01323-001, Brazil"},{"name":"Clinics Hospital, Faculty of Medicine, University of Sao Paulo, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo Barreira","family":"Portella","sequence":"additional","affiliation":[{"name":"Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo 01323-001, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor Hugo Rocha","family":"Marussi","sequence":"additional","affiliation":[{"name":"Benefic\u00eancia Portuguesa Hospital, S\u00e3o Paulo 01323-001, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmen Lucia Penteado","family":"Lancellotti","sequence":"additional","affiliation":[{"name":"Faculty of Medical Sciences, Santa Casa de S\u00e3o Paulo, S\u00e3o Paulo 01224-001, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paulo Ribeiro","family":"Nobrega","sequence":"additional","affiliation":[{"name":"Division of Neurology, Walter Cantidio University Hospital, Federal University of Ceara, Prof. Costa Mendes St., 1608, 4th Floor, Rodolfo Te\u00f3filo, Fortaleza 60430-140, Brazil"},{"name":"Faculty of Medicine, Centro Universit\u00e1rio Christus, Fortaleza 60160-230, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9764-3763","authenticated-orcid":false,"given":"Guilherme Diogo","family":"Silva","sequence":"additional","affiliation":[{"name":"Clinics Hospital, Faculty of Medicine, University of Sao Paulo, S\u00e3o Paulo 05403-010, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,8,11]]},"reference":[{"key":"ref_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"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1007\/s11940-017-0455-4","article-title":"Therapeutic Approaches in CLIPPERS","volume":"19","author":"Taieb","year":"2017","journal-title":"Curr. 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(P1.336)","volume":"88","author":"Horng","year":"2017","journal-title":"Neurology"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"327","DOI":"10.25259\/SNI_355_2021","article-title":"Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids: A Case Report and Literature Review","volume":"12","author":"Sudhakar","year":"2021","journal-title":"Surg. Neurol. Int."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"989","DOI":"10.1212\/NXI.0000000000000989","article-title":"CLIPPERS With Exclusive Extra Pontine Involvement","volume":"8","author":"Picarelli","year":"2021","journal-title":"Neurol. Neuroimmunol. 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Investig."}],"container-title":["Brain Sciences"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/8\/1191\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:31:28Z","timestamp":1760128288000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-3425\/13\/8\/1191"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,8,11]]},"references-count":16,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2023,8]]}},"alternative-id":["brainsci13081191"],"URL":"https:\/\/doi.org\/10.3390\/brainsci13081191","relation":{},"ISSN":["2076-3425"],"issn-type":[{"value":"2076-3425","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,8,11]]}}}