{"id":"ee12d7c9-9691-4f62-959d-eabc40841eab","slug":"supratentorial-lymphocytic-inflammation-with-parenchymal-perivascular-enhancement-responsive-to-steroids-a-case-report-and-literature-review","title":"Supratentorial lymphocytic inflammation with parenchymal perivascular enhancement responsive to steroids: A case report and literature review","authors":["Vivek Sudhakar","Zachary Gersey","Sean P. Polster","Megan Mantica","George Zenonos"],"abstract":"Background: Chronic Lymphocytic Inflammation with Pontine Perivascular Enhancement Responsive to Steroids is a rare disorder that presents with subacute brainstem symptoms such as ataxia, facial paresthesias, and episodic diplopia, thought to be due to a T-cell medicated perivascular inflammatory process. A supratentorial variant, Supratentorial Lymphocytic Inflammation with Parenchymal Perivascular Enhancement Responsive to Steroids (SLIPPERS), has been described in only three patients. Case Description: A 71-year-old male presented with word-finding difficulties, confusion, and left leg weakness. Radiographic workup demonstrated multiple supratentorial ring-enhancing lesions. PET/CT demonstrated hypermetabolism and susceptibility-weighted imaging demonstrated a hemorrhagic component. Frozen pathology revealed a predominately T-cell and monocyte inflammatory infiltrate. He demonstrated interval improvement to dexamethasone therapy, but then demonstrated worsening of his symptoms following discontinuation. Conclusion: Given his dramatic response to corticosteroids, he was diagnosed with SLIPPERS. SLIPPERS is an underrecognized diagnostic entity to consider in patients with ring-enhancing lesions and can present with hypermetabolic lesions on PET/CT.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/ee12d7c9-9691-4f62-959d-eabc40841eab/featured/hero-1781562254604.png","publishDate":"2021-07-06T00:00:00.000Z","doi":"10.25259/SNI_355_2021","categories":["General Neurosurgery","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/ee12d7c9-9691-4f62-959d-eabc40841eab/pdf"}