Appearance and Disappearance of Callosal Lesions in Susac Syndrome

Susac Syndrome (SS) is a B cell mediated endotheliopathy associated with vision loss, hearing loss, and encephalopathy. Common sites of involvement are the very small arterioles such as those in the corpus callosum and retinal arterioles. The diagnosis can be confirmed either by central callosal lesions on magnetic resonance imaging (MRI) or fluorescein angiographic (FA) staining remote from branch retinal artery occlusion. The pathophysiology in these cases is likely due to antibody deposition on endothelial cells resulting in infarction. It is unknown if all acute callosal lesions will cavitate into callosal holes but this is a common belief. We describe 3 patients who had acute callosal lesions at first examination that resolved without sequelae of hole development on subsequent neuroimaging.