"Peppering the pons": CLIPPERS or myelin oligodendrocyte glycoprotein associated disease?

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is a distinct pathologic entity of unknown etiology. Here, we describe the clinical and radiologic presentation of myelin oligodendrocyte glycoprotein associated disease (MOG-AD) with features mimicking CLIPPERS. Three patients met the 2017 CLIPPERS diagnostic criteria, while one patient had a single lesion in the pons that mimicked CLIPPERS lesions. All had an excellent response to steroids, but the three who met the CLIPPERS criteria had a relapsing course. When CLIPPERS is observed, it is crucial to test for mimickers. The ever-expanding spectrum of MOG-AD calls for further research into the immunopathogenesis of its several phenotypes.

Anti-myelin oligodendrocyte glycoprotein (MOG) associated disease masquerading as prolonged intractable nausea and vomiting.

The clinical and radiological spectrum of myelin oligodendrocyte glycoprotein (MOG) antibody associated disease continues to expand. Here, we describe a case of prolonged, relapsing, intractable nausea and vomiting misdiagnosed as a functional disorder for more than one year. The patient did not receive a neurological workup until clear neurological signs developed. This case exemplifies the delay in diagnosis when neurological disease presents with seemingly non-neurological symptoms and illustrates brainstem and upper spinal cord radiological findings that can help guide the treating physician to test for MOG antibodies and provide the appropriate treatment.