Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) was first described in 2010 and to this date, approximately 50 cases have been published worldwide. We present the case of a young man presenting with hemiparesis, dysphagia, diplopia and abnormal gait. Such a case had not heretofore been described in this southern region of Colombia.

Case Study - A 28-year-old male with an unremarkable medical history presented at an emergency department in southern Colombia with an acute history of intense left-sided headache with associated nausea and ipsilateral facial weakness. After discharge with a negative non-contrast head CT he developed vertigo, right-sided hemiparesis, dysphagia, diplopia and abnormal gait and was readmitted to a public University Hospital with suspicion of a left-sided pontine demyelinating condition. Routine bloodwork, a high-dose pulse of intravenous steroids, a lumbar puncture and a constrast brain MRI were ordered on admission.

A CSF opening pressure of 28 cm H2O and hyperintense T2 and FLAIR enhancing lesions in the rostral pons and cerebellar peduncles were found, diagnostic work-up was otherwise unremarkable. Patient had a favorable response to treatment and was discharged. At a 1 month follow-up he was successfully weaned off of steroids to mycophenolate and had returned to baseline. There has been no evidence of relapse 6 months after initial presentation.

CLIPPERS is an inflammatory disorder of the brainstem, the etiology of which is uncertain, but likely immune-mediated by an unknown trigger. The diagnosis of CLIPPERS is one of exclusion, but common clinical features include diplopia, ataxia and facial paresthesias. Supporting radiological features include curvilinear gadolinium-enhancing "peppering" lesions on MRI mainly in the pons but also present in the medulla, cerebellum, midbrain and spinal cord. Early use of high-dose glucocorticoids is effective and most patients require long-term immunosuppressive therapy to prevent relapse.