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Neurological Rehabilitation

Rare Case of Susac Syndrome Presenting as Corpus Callosum Infarct: A Case Report

Thursday, October 23, 2025
5:00 PM - 6:30 PM MT
Location: Open Kiosks

    Primary Author(s)

  • MH

    Morgan Howells-Resendez, MD (she/her/hers)

    Resident Physician
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

    • Co-Author(s)

  • GS

    Gina Saad, BSN

    Medical Student
    Saint Georges University School of Medicine
    Brooklyn, New York

    • Poster Presenter(s)

  • ES

    Emma Spilsted, MD

    Resident Physician
    East Carolina University Medical Center
    Greenville, North Carolina

    • Co-Author(s)

  • Samantha Greenman, DO

    Resident Physician
    ECU Health (Vidant Medical Center/East Carolina University) PM&R Program
    Greenville, North Carolina

Disclosure(s):
Morgan Howells-Resendez, MD: No financial relationships to disclose
Emma Spilsted, MD: No financial relationships to disclose
Samantha Greenman, DO: No financial relationships to disclose
Case Diagnosis: 52 year-old man with encephalopathy, vision deficits, and corpus callosum infarct diagnosed with Susac syndrome (SS)

Case Description or Program Description: 52 year-old male with hypertension presented to the emergency department with congestive heart failure exacerbation requiring diuresis. Per family, patient with recent auditory and visual deficits. During admission, patient developed altered mental status (AMS), and MRI brain noted acute corpus callosum infarct with “snowball-like” appearance. Given encephalopathy and corpus callosum infarct, neurology and ophthalmology were consulted for SS evaluation. Ophthalmology evaluated patient and noted bilateral vitreous hemorrhage and retinopathy consistent with branch retinal artery occlusion (BRAO). Audiological testing was deferred due to AMS. Given concern for SS, patient was started on high dose steroids.

Setting: Inpatient Rehabilitation

Assessment/Results: The patient had partial neurological recovery with long steroid taper. Encephalopathy resolved, however patient continues to follow with neurology and ophthalmology for persistent neurological and ophthalmological deficits.

Discussion (relevance): SS is a rare immune-mediated microvascular disease with diagnostic triad of encephalopathy, BRAO, and sensorineural hearing loss. . While the pathogenesis is not fully understood, anti-endothelial cell antibodies play a role in the antibody response leading to microangiopathy and cell injury, leading to subsequent deposition of thrombotic material in the lumen of small vessels. In most cases, the corpus callosum is seen to be involved, specifically the central area. On MRI, microinfarcts have a rounded “snowball appearance.” Definite treatment for SS has not been identified due to the rare nature of the disease. Current treatment regimen includes high dose steroids, with antithrombotic and antiplatelet agents.

Conclusions: This case highlights the importance of obtaining a thorough history from patients or collateral sources in cases of AMS. In this case, correct treatment could have been missed or delayed without history of visual and auditory deficits obtained from family members. In the case of SS, early recognition and treatment can prevent severe neurological deficits.