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

BMJ Case Rep. 2019 Aug 30;12(8):e229422. 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.

Keywords: brain stem / cerebellum; neuroimaging; psychiatry.

Publication types

  • Case Reports

MeSH terms

  • Confusion / diagnosis*
  • Confusion / psychology
  • Diagnosis, Differential
  • Dissociative Disorders / diagnosis*
  • Dissociative Disorders / psychology
  • Female
  • Humans
  • Middle Aged
  • Susac Syndrome / diagnosis*
  • Susac Syndrome / psychology