[The Susac syndrome--a retinocochleocerebral angiopathy].
BACKGROUND
There has been a series of case reports of otherwise healthy patients suffering from microangiopathy of the brain, retina and cochlea. Most patients were young women presenting clinically with a subacute encephalopathy, branch retina artery occlusions, and hearing loss. In 1994 the name "Susac syndrome" has been proposed for this disease entity.


METHODS
Case report and review of 64 published cases, identified through MEDLINE are given.


METHODS
We describe a 32-year-old otherwise healthy woman presenting with a subacute encephalopathy, multiple branch retinal artery occlusions and bilateral hearing loss. MRI of the brain revealed multiple small white and grey matter lesions without contrast enhancement. CSF protein was elevated, oligoclonal bands were negative. Immunological laboratory parameters, microbiology, virology, coagulation studies, SEP, AEP, VEP and cerebral DSA were normal.


METHODS
Of 64 identified patients 58 were women. The mean age of the patients was 30 years. 60 patients (94%) had arterial occlusions, which were bilateral in 39%. 48 patients reported hearing loss, 37 patients (58%) had a global encephalopathy, but other neurologic manifestations were common.


CONCLUSIONS
This rare syndrome has a strong young female preponderance. MRI of the brain often shows lesions suggestive of multiple sclerosis. Fluorescein angiography may show arteriolar wall hyperfluorescence. Patients can be identified at an early stage with a careful history and physical examination. Early treatment with corticosteroids is often associated with a good prognosis. Cyclophosphamide and antiplatelet drugs may be added in complicated cases.
Winterholler
M
M
Neurologische Klinik, Friedrich-Alexander-Universitat, Erlangen. wiho.erlangen@t-online.de
Lang
C
C
Schonherr
U
U
Heckmann
J G
JG
Neundorfer
B
B
D000328:Adult; D002556:Cerebrospinal Fluid Proteins; D002561:Cerebrovascular Disorders / Q000473:pathology*; D003051:Cochlea / Q000473:pathology*; D005260:Female; D006312:Hearing Loss, Bilateral / Q000473:pathology; D006801:Humans; D007759:Labyrinth Diseases / Q000134:cerebrospinal fluid / Q000473:pathology*; D008279:Magnetic Resonance Imaging; D016491:Peripheral Vascular Diseases / Q000134:cerebrospinal fluid / Q000473:pathology*; D015356:Retinal Artery Occlusion / Q000134:cerebrospinal fluid / Q000473:pathology*; D013577:Syndrome
D002556:Cerebrospinal Fluid Proteins