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Confusion, dissociation and bizarre behaviour as the onset of an early Susac syndrome
  1. Marta Pérez-Lombardo1,
  2. Íñigo Alberdi-Páramo1,
  3. Belén Ramos-Barragán2 and
  4. Diana Gimeno-Álvarez1
  1. 1 Instituto de Psiquiatría y Salud Mental, Hospital Universitario Clínico San Carlos, Madrid, Spain
  2. 2 Hospital Universitario Virgen del Rocío, Sevilla, Spain
  1. Correspondence to Marta Pérez-Lombardo, martaperezlombardo{at}


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.

  • neuroimaging
  • brain stem / cerebellum
  • psychiatry

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  • Contributors MP-L: study concept and design, drafting of the manuscript, data collection and interpretation. IA-P: critical revision of the manuscript, analysis and interpretation of data. BR-B: critical revision and design of the manuscript, interpretation of data. DG-A: supervisor of the study, collection and interpretation of data, critical revision of the manuscript. All authors provided final approval of the version to be published and are guarantors.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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