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MRI findings in Susac’s syndrome

From Neurology and Neurosurgery Associates (Dr. Susac), Winter Haven, FL; University of South Florida (Dr. Murtagh), Tampa; Casey Eye Institute (Dr. Egan), Portland, OR; University of Kentucky (Dr. Berger), Lexington; Buffalo General Hospital (Drs. Bakshi and Lincoff), NY; University of California (Drs. Gean and Layzer), San Francisco; University of Pennsylvania (Dr. Galetta), Philadelphia; Cleveland Clinic (Dr. Fox), OH; The Ottawa Hospital (Dr. Costello), Canada; University of Iowa (Dr. Lee), Iowa City; Scott & White Clinic (Dr. Clark), Temple, TX; and Case Western Reserve University (Dr. Daroff), Cleveland, OH.

Address correspondence and reprint requests to Dr. John O. Susac, Neurology and Neurosurgery Associates, 50 Second Street, S.E., Winter Haven, FL 33880; jsusac{at}neurohaven.com

Background: Susac syndrome (SS) is a self-limited syndrome, presumably autoimmune, consisting of a clinical triad of encephalopathy, branch retinal artery occlusions, and hearing loss. All three elements of the triad may not be present or recognized, and MR imaging is often necessary to establish the diagnosis.

Objective: To determine the spectrum of abnormalities on MRI in SS.

Methods: The authors reviewed the MR images of 27 previously unreported patients with the clinical SS triad, and 51 patients from published articles in which the MR images were depicted or reported.

Results: All 27 patients had multifocal supratentorial white matter lesions including the corpus callosum. The deep gray nuclei (basal ganglia and thalamus) were involved in 19 (70%). Nineteen (70%) also had parenchymal enhancement and 9 (33%) had leptomeningeal enhancement. Of the 51 cases from the literature, at least 32 had callosal lesions. The authors could not determine the presence of callosal lesions in 18 of these patients, and only one was reported to have a normal MRI at the onset of encephalopathy.

Conclusions: The MR scans in SS show a rather distinctive pattern of supratentorial white matter lesions that always involve the corpus callosum. There is often deep gray matter, posterior fossa involvement, and frequent parenchymal with occasional leptomeningeal enhancement. The central callosal lesions differ from those in demyelinating disease, and should support the diagnosis of SS in patients with at least two of the three features of the clinical triad.

Received July 28, 2003. Accepted in final form October 17, 2003.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the December 23 issue to find the title link for this article.

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