Abstract

The presentation of a patient with brainstem signs and symptoms requires a series of common and less common differential diagnoses. An accurate diagnosis can be a challenge. We review the principal inflammatory and immune-mediated syndromes that may affect the brainstem, including multiple sclerosis, neuromyelitis optica spectrum disorder, neuro-Behçet's disease, chronic lymphocytic inflammation with pontine perivascular enhancement that responds to steroids (CLIPPERS), neurosarcoidosis, and Susac syndrome. We focus on the clinical characteristics and magnetic resonance imaging clues that help distinguish between the different brainstem diseases. A precise diagnosis is important for guiding appropriate treatment and limiting neurological disability.

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