Diagnosis:
Clinical features, MRI and occasionally biopsy
Clinical features:
Episodic diplopia or facial paresthesias with subsequent brainstem and occasionally myelopathic symptoms and had a favourable initial response to high dose glucocorticosteroids
Findings on Investigations:
+MRI:
- Symmetric curvilinear gadolinium enhancement peppering the pons and extending variably into the medulla, brachium pontis, cerebellum, midbrain and occasionally spinal cord
Pathology:
white matter perivascular, predominantly T lymphocytic, infiltrate without granulomas
Treatment:
Glucocorticosteroids, if unable to taper add on other immunosuppressants