Case report

A 54-year-old man had a 12 month history of weakness of both lower limbs with urge urinary incontinence, 6 month history of visual loss and hearing impairment and a 1 month history of cognitive dysfunction. He had no constitutional symptoms. On examination, his visual acuity was reduced to perception of light only in both eyes; funduscopy identified branch retinal artery occlusion (figure 1). He had spastic weakness and hyperreflexia in the lower limbs. Pure-tone audiometry suggested severe sensorineural hearing loss. MR scan of the brain showed characteristic features of Susac’s syndrome (figure 2). Following high-dose methylprednisolone pulses, intravenous immunoglobulin and rituximab, …