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### Selected Images
![Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='/img/arrows/WO.png'/> and medulla <img src='/img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_3b810ab1-5bad-4ec7-936d-bc3cf0683b4d_annotated_true_size_900_quality_90_665175a0_20251018T122457Z.jpg)
*Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='/img/arrows/WO.png'/> and medulla <img src='/img/arrows/WS.png'/>.*
![Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='img/arrows/WO.png'/> and medulla <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_3b810ab1-5bad-4ec7-936d-bc3cf0683b4d_annotated_true_size_900_quality_90_665175a0_20251018T122457Z.jpg)
*Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='img/arrows/WO.png'/> and medulla <img src='img/arrows/WS.png'/>.*
![Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='/img/arrows/WO.png'/> and medulla <img src='/img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_3b810ab1-5bad-4ec7-936d-bc3cf0683b4d_size_168_quality_85_8ebb6805_20251018T095255Z.jpg)
*Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='/img/arrows/WO.png'/> and medulla <img src='/img/arrows/WS.png'/>.*
![Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='img/arrows/WO.png'/> and medulla <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_3b810ab1-5bad-4ec7-936d-bc3cf0683b4d_size_168_quality_85_8ebb6805_20251018T095255Z.jpg)
*Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='img/arrows/WO.png'/> and medulla <img src='img/arrows/WS.png'/>.*
![Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='/img/arrows/WO.png'/> and medulla <img src='/img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_3b810ab1-5bad-4ec7-936d-bc3cf0683b4d_size_174_quality_85_03245c01_20251018T122441Z.jpg)
*Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='/img/arrows/WO.png'/> and medulla <img src='/img/arrows/WS.png'/>.*
![Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='img/arrows/WO.png'/> and medulla <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_3b810ab1-5bad-4ec7-936d-bc3cf0683b4d_size_174_quality_85_03245c01_20251018T122441Z.jpg)
*Sagittal FLAIR MR in a 56-year-old woman with weight loss and a 3-week history of diplopia and disequilibrium shows confluent and punctate hyperintensities in the pons <img src='img/arrows/WO.png'/> and medulla <img src='img/arrows/WS.png'/>.*
![Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.](images/app.statdx.com_image_thumbnail_0412a98f-922e-4e0e-8106-5bf10bac5e68_annotated_true_size_900_quality_90_1e116da8_20251018T122457Z.jpg)
*Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.*
![Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.](images/app.statdx.com_image_thumbnail_0412a98f-922e-4e0e-8106-5bf10bac5e68_annotated_true_size_900_quality_90_1e116da8_20251018T122457Z.jpg)
*Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.*
![Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.](images/app.statdx.com_image_thumbnail_0412a98f-922e-4e0e-8106-5bf10bac5e68_size_168_quality_85_3093054b_20251018T095255Z.jpg)
*Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.*
![Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.](images/app.statdx.com_image_thumbnail_0412a98f-922e-4e0e-8106-5bf10bac5e68_size_168_quality_85_3093054b_20251018T095255Z.jpg)
*Axial T1 C+ MR in the same patient shows multiple punctate and curvilinear enhancing foci &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/>. Additional lesions are present in both cerebellar peduncles, vermis, and the left cerebellar hemisphere.*
![More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='/img/arrows/WS.png'/> and curvilinear <img src='/img/arrows/WC.png'/> lesions involving the upper pons.](images/app.statdx.com_image_thumbnail_bbe0d150-9cfd-4e4c-b8ca-2d1adceadb6b_annotated_true_size_900_quality_90_8ea0b444_20251018T122457Z.jpg)
*More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='/img/arrows/WS.png'/> and curvilinear <img src='/img/arrows/WC.png'/> lesions involving the upper pons.*
![More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='img/arrows/WS.png'/> and curvilinear <img src='img/arrows/WC.png'/> lesions involving the upper pons.](images/app.statdx.com_image_thumbnail_bbe0d150-9cfd-4e4c-b8ca-2d1adceadb6b_annotated_true_size_900_quality_90_8ea0b444_20251018T122457Z.jpg)
*More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='img/arrows/WS.png'/> and curvilinear <img src='img/arrows/WC.png'/> lesions involving the upper pons.*
![More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='/img/arrows/WS.png'/> and curvilinear <img src='/img/arrows/WC.png'/> lesions involving the upper pons.](images/app.statdx.com_image_thumbnail_bbe0d150-9cfd-4e4c-b8ca-2d1adceadb6b_size_168_quality_85_d66f7fff_20251018T095255Z.jpg)
*More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='/img/arrows/WS.png'/> and curvilinear <img src='/img/arrows/WC.png'/> lesions involving the upper pons.*
![More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='img/arrows/WS.png'/> and curvilinear <img src='img/arrows/WC.png'/> lesions involving the upper pons.](images/app.statdx.com_image_thumbnail_bbe0d150-9cfd-4e4c-b8ca-2d1adceadb6b_size_168_quality_85_d66f7fff_20251018T095255Z.jpg)
*More cephalad T1 C+ MR scan in the same patient shows the punctate <img src='img/arrows/WS.png'/> and curvilinear <img src='img/arrows/WC.png'/> lesions involving the upper pons.*
![Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='/img/arrows/WO.png'/> and inferior extension into the medulla <img src='/img/arrows/WC.png'/> and upper cervical cord <img src='/img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.](images/app.statdx.com_image_thumbnail_014b1c32-e926-4656-987e-d8311c674576_annotated_true_size_900_quality_90_8455b9a1_20251018T122457Z.jpg)
*Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='/img/arrows/WO.png'/> and inferior extension into the medulla <img src='/img/arrows/WC.png'/> and upper cervical cord <img src='/img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.*
![Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='img/arrows/WO.png'/> and inferior extension into the medulla <img src='img/arrows/WC.png'/> and upper cervical cord <img src='img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.](images/app.statdx.com_image_thumbnail_014b1c32-e926-4656-987e-d8311c674576_annotated_true_size_900_quality_90_8455b9a1_20251018T122457Z.jpg)
*Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='img/arrows/WO.png'/> and inferior extension into the medulla <img src='img/arrows/WC.png'/> and upper cervical cord <img src='img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.*
![Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='/img/arrows/WO.png'/> and inferior extension into the medulla <img src='/img/arrows/WC.png'/> and upper cervical cord <img src='/img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.](images/app.statdx.com_image_thumbnail_014b1c32-e926-4656-987e-d8311c674576_size_168_quality_85_e2ebbeb7_20251018T095255Z.jpg)
*Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='/img/arrows/WO.png'/> and inferior extension into the medulla <img src='/img/arrows/WC.png'/> and upper cervical cord <img src='/img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.*
![Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='img/arrows/WO.png'/> and inferior extension into the medulla <img src='img/arrows/WC.png'/> and upper cervical cord <img src='img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.](images/app.statdx.com_image_thumbnail_014b1c32-e926-4656-987e-d8311c674576_size_168_quality_85_e2ebbeb7_20251018T095255Z.jpg)
*Coronal T1 C+ FS MR in the same patient shows the lesions &quot;peppering&quot; the pons. Note cephalad extension into the cerebral peduncles <img src='img/arrows/WO.png'/> and inferior extension into the medulla <img src='img/arrows/WC.png'/> and upper cervical cord <img src='img/arrows/WS.png'/>. DSA (not shown) was negative. The lesions resolved with corticosteroids, so this is a presumed case of CLIPPERS.*
### Additional Images
![Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='/img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_b7924d60-22a9-44a8-8eab-a122a8fabee9_annotated_true_size_900_quality_90_e520a898_20251018T122457Z.jpg)
*Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='/img/arrows/WS.png'/>.*
![Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_b7924d60-22a9-44a8-8eab-a122a8fabee9_annotated_true_size_900_quality_90_e520a898_20251018T122457Z.jpg)
*Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='img/arrows/WS.png'/>.*
![Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='/img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_b7924d60-22a9-44a8-8eab-a122a8fabee9_size_168_quality_85_afe982f1_20251018T095255Z.jpg)
*Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='/img/arrows/WS.png'/>.*
![Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_b7924d60-22a9-44a8-8eab-a122a8fabee9_size_168_quality_85_afe982f1_20251018T095255Z.jpg)
*Sagittal FLAIR in a 52-year-old man with diplopia, dysarthria, and facial numbness shows confluent hyperintensity in the pons <img src='img/arrows/WS.png'/>.*
![Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='/img/arrows/WS.png'/> as well as larger confluent, nodular <img src='/img/arrows/WO.png'/>, and partial ring-enhancing <img src='/img/arrows/WC.png'/> lesions in the pons.](images/app.statdx.com_image_thumbnail_54794f9e-0cff-4b09-8514-3f0c0f658cbd_annotated_true_size_900_quality_90_3d84ec59_20251018T122457Z.jpg)
*Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='/img/arrows/WS.png'/> as well as larger confluent, nodular <img src='/img/arrows/WO.png'/>, and partial ring-enhancing <img src='/img/arrows/WC.png'/> lesions in the pons.*
![Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='img/arrows/WS.png'/> as well as larger confluent, nodular <img src='img/arrows/WO.png'/>, and partial ring-enhancing <img src='img/arrows/WC.png'/> lesions in the pons.](images/app.statdx.com_image_thumbnail_54794f9e-0cff-4b09-8514-3f0c0f658cbd_annotated_true_size_900_quality_90_3d84ec59_20251018T122457Z.jpg)
*Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='img/arrows/WS.png'/> as well as larger confluent, nodular <img src='img/arrows/WO.png'/>, and partial ring-enhancing <img src='img/arrows/WC.png'/> lesions in the pons.*
![Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='/img/arrows/WS.png'/> as well as larger confluent, nodular <img src='/img/arrows/WO.png'/>, and partial ring-enhancing <img src='/img/arrows/WC.png'/> lesions in the pons.](images/app.statdx.com_image_thumbnail_54794f9e-0cff-4b09-8514-3f0c0f658cbd_size_168_quality_85_ca6dda0c_20251018T095255Z.jpg)
*Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='/img/arrows/WS.png'/> as well as larger confluent, nodular <img src='/img/arrows/WO.png'/>, and partial ring-enhancing <img src='/img/arrows/WC.png'/> lesions in the pons.*
![Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='img/arrows/WS.png'/> as well as larger confluent, nodular <img src='img/arrows/WO.png'/>, and partial ring-enhancing <img src='img/arrows/WC.png'/> lesions in the pons.](images/app.statdx.com_image_thumbnail_54794f9e-0cff-4b09-8514-3f0c0f658cbd_size_168_quality_85_ca6dda0c_20251018T095255Z.jpg)
*Axial T1 C+ MR shows scattered, faint, punctate enhancing foci <img src='img/arrows/WS.png'/> as well as larger confluent, nodular <img src='img/arrows/WO.png'/>, and partial ring-enhancing <img src='img/arrows/WC.png'/> lesions in the pons.*
![Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='/img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.](images/app.statdx.com_image_thumbnail_179e89fa-d5c6-4f10-b298-b1179723c303_annotated_true_size_900_quality_90_df3edd4b_20251018T122457Z.jpg)
*Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='/img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.*
![Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.](images/app.statdx.com_image_thumbnail_179e89fa-d5c6-4f10-b298-b1179723c303_annotated_true_size_900_quality_90_df3edd4b_20251018T122457Z.jpg)
*Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.*
![Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='/img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.](images/app.statdx.com_image_thumbnail_179e89fa-d5c6-4f10-b298-b1179723c303_size_168_quality_85_f7ef21fc_20251018T095255Z.jpg)
*Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='/img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.*
![Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.](images/app.statdx.com_image_thumbnail_179e89fa-d5c6-4f10-b298-b1179723c303_size_168_quality_85_f7ef21fc_20251018T095255Z.jpg)
*Coronal T1 C+ MR in the same patient shows large, confluent, patchy enhancing lesions <img src='img/arrows/WS.png'/> in the pons. Differential diagnosis included lymphoma, lymphomatoid granulomatosis, vasculitis, and CLIPPERS. The patient improved on steroids.*
![Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/> and medulla <img src='/img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='/img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_6b5d2b9c-b124-4a6a-beba-fe65179bd0b6_annotated_true_size_900_quality_90_fc0ab4e1_20251018T122457Z.jpg)
*Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/> and medulla <img src='/img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='/img/arrows/WO.png'/>.*
![Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/> and medulla <img src='img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_6b5d2b9c-b124-4a6a-beba-fe65179bd0b6_annotated_true_size_900_quality_90_fc0ab4e1_20251018T122457Z.jpg)
*Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/> and medulla <img src='img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='img/arrows/WO.png'/>.*
![Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/> and medulla <img src='/img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='/img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_6b5d2b9c-b124-4a6a-beba-fe65179bd0b6_size_168_quality_85_07b4c70d_20251018T095255Z.jpg)
*Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='/img/arrows/WS.png'/> and medulla <img src='/img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='/img/arrows/WO.png'/>.*
![Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/> and medulla <img src='img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='img/arrows/WO.png'/>.](images/app.statdx.com_image_thumbnail_6b5d2b9c-b124-4a6a-beba-fe65179bd0b6_size_168_quality_85_07b4c70d_20251018T095255Z.jpg)
*Sagittal FLAIR in the same patient obtained a year later when symptoms relapsed off steroids shows multiple punctate hyperintensities &quot;peppering&quot; the pons <img src='img/arrows/WS.png'/> and medulla <img src='img/arrows/WC.png'/>. Note extension into upper spinal cord <img src='img/arrows/WO.png'/>.*
![Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='/img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.](images/app.statdx.com_image_thumbnail_f849c125-5528-4f44-943a-db3c921f3a9b_annotated_true_size_900_quality_90_1b2921c8_20251018T122500Z.jpg)
*Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='/img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.*
![Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.](images/app.statdx.com_image_thumbnail_f849c125-5528-4f44-943a-db3c921f3a9b_annotated_true_size_900_quality_90_1b2921c8_20251018T122500Z.jpg)
*Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.*
![Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='/img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.](images/app.statdx.com_image_thumbnail_f849c125-5528-4f44-943a-db3c921f3a9b_size_168_quality_85_7fa9d5c0_20251018T095255Z.jpg)
*Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='/img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.*
![Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.](images/app.statdx.com_image_thumbnail_f849c125-5528-4f44-943a-db3c921f3a9b_size_168_quality_85_7fa9d5c0_20251018T095255Z.jpg)
*Axial T1 C + FS MR in the same patient shows small, punctate foci of enhancement <img src='img/arrows/WS.png'/> &quot;peppering&quot; the pons, cerebellar peduncles.*
![More inferior T1 C+ FS MR in the same patient shows additional small enhancing foci in the medulla <img src='/img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_b1bf1bf1-9d90-4fe9-905b-3b85debd861f_size_168_quality_85_2931bc9a_20251018T095255Z.jpg)
*More inferior T1 C+ FS MR in the same patient shows additional small enhancing foci in the medulla <img src='/img/arrows/WS.png'/>.*
![More inferior T1 C+ FS MR in the same patient shows additional small enhancing foci in the medulla <img src='img/arrows/WS.png'/>.](images/app.statdx.com_image_thumbnail_b1bf1bf1-9d90-4fe9-905b-3b85debd861f_size_168_quality_85_2931bc9a_20251018T095255Z.jpg)
*More inferior T1 C+ FS MR in the same patient shows additional small enhancing foci in the medulla <img src='img/arrows/WS.png'/>.*
![More cephalad T1 C+ FS MR in the same patient shows additional lesions in the midbrain <img src='/img/arrows/WS.png'/> and medial temporal lobe <img src='/img/arrows/WC.png'/>.](images/app.statdx.com_image_thumbnail_56b83112-4e12-4510-beff-f833b9599c27_size_168_quality_85_dab3c1ff_20251018T095255Z.jpg)
*More cephalad T1 C+ FS MR in the same patient shows additional lesions in the midbrain <img src='/img/arrows/WS.png'/> and medial temporal lobe <img src='/img/arrows/WC.png'/>.*
![More cephalad T1 C+ FS MR in the same patient shows additional lesions in the midbrain <img src='img/arrows/WS.png'/> and medial temporal lobe <img src='img/arrows/WC.png'/>.](images/app.statdx.com_image_thumbnail_56b83112-4e12-4510-beff-f833b9599c27_size_168_quality_85_dab3c1ff_20251018T095255Z.jpg)
*More cephalad T1 C+ FS MR in the same patient shows additional lesions in the midbrain <img src='img/arrows/WS.png'/> and medial temporal lobe <img src='img/arrows/WC.png'/>.*
![More cephalad T1 C+ FS MR in the same patient shows a solitary enhancing lesion <img src='/img/arrows/WS.png'/> in the subcortical white matter of the &quot;hand knob.&quot; One of the cerebellar lesions was biopsied and disclosed CD4+ T-cell perivascular infiltrates, consistent with CLIPPERS. In rare cases, CLIPPERS initially manifests as a more mass-like confluent pontine lesion before the typical peppering pattern emerges.](images/app.statdx.com_image_thumbnail_784cb251-3014-4189-b444-0f63b0f2a125_size_168_quality_85_1dac933c_20251018T095255Z.jpg)
*More cephalad T1 C+ FS MR in the same patient shows a solitary enhancing lesion <img src='/img/arrows/WS.png'/> in the subcortical white matter of the &quot;hand knob.&quot; One of the cerebellar lesions was biopsied and disclosed CD4+ T-cell perivascular infiltrates, consistent with CLIPPERS. In rare cases, CLIPPERS initially manifests as a more mass-like confluent pontine lesion before the typical peppering pattern emerges.*
![More cephalad T1 C+ FS MR in the same patient shows a solitary enhancing lesion <img src='img/arrows/WS.png'/> in the subcortical white matter of the &quot;hand knob.&quot; One of the cerebellar lesions was biopsied and disclosed CD4+ T-cell perivascular infiltrates, consistent with CLIPPERS. In rare cases, CLIPPERS initially manifests as a more mass-like confluent pontine lesion before the typical peppering pattern emerges.](images/app.statdx.com_image_thumbnail_784cb251-3014-4189-b444-0f63b0f2a125_size_168_quality_85_1dac933c_20251018T095255Z.jpg)
*More cephalad T1 C+ FS MR in the same patient shows a solitary enhancing lesion <img src='img/arrows/WS.png'/> in the subcortical white matter of the &quot;hand knob.&quot; One of the cerebellar lesions was biopsied and disclosed CD4+ T-cell perivascular infiltrates, consistent with CLIPPERS. In rare cases, CLIPPERS initially manifests as a more mass-like confluent pontine lesion before the typical peppering pattern emerges.*