Susac's syndrome

Susac's syndrome is being recognised more frequently, not only because of the increasing use of MRI and awareness of the suggestive abnormalities, but also because of the realisation that the clinical presentation may be much varied:

• One or two of the classical triad may be absent symptomatically and/or be difficult to detect clinically, especially at presentation but often beyond.

• The time course is often fluctuating and prolonged over many weeks or months, so one can no longer rely on clinical progression as a ‘red flag’ or to yield diagnostically helpful involvement of the retina/cochlear/brain.

Diagnostic difficulties are compounded by the not unusual early picture of a youngish woman with headaches often described as migrainous, with or …