Confusion, dissociation and bizarre behaviour as the onset of an early Susac syndrome

• Published in: BMJ case reports 2019-08, Vol.12 (8), p.e229422
• Main Authors: Pérez-Lombardo, Marta, Alberdi-Páramo, Íñigo, Ramos-Barragán, Belén, Gimeno-Álvarez, Diana
• Format: Article
• Language: English
• Subjects: Anxiety; Case reports; Cognitive ability; Confusion - diagnosis; Confusion - psychology; Diagnosis, Differential; Dissociative Disorders - diagnosis; Dissociative Disorders - psychology; Female; Hearing loss; Humans; Insomnia; Middle Aged; Neuroimaging; Rare Disease; Semantics; Susac Syndrome - diagnosis; Susac Syndrome - psychology
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-229422

A 47-year-old woman presented an episode of confusion and disorientation. According to remarkable psychiatric records, she had been treated for major depression and obsessive-compulsive disorder; however, no other relevant background was known. After preliminary examinations, blood analysis and neurological tests were unspecific and inconclusive. Therefore, the case was treated as a possible psychiatric episode related to her previous psychiatric disorders. However, due to the atypical presentation of the case, a cerebral MRI was performed, which demonstrated multiple central lesions of the corpus callosum (‘snowball lesions’), as well as several supratentorial white matter lesions. As a result of the follow-up of the case, sensorineural hearing loss and branch retinal artery were detected, which concluded in the classic triad and the confirmation of the diagnosis of a Susac syndrome.