Diagnostic Criteria and Treatment Algorithm for Susac Syndrome

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Title Diagnostic Criteria and Treatment Algorithm for Susac Syndrome
Creator Robert A. Egan
Affiliation Department of Neurology and Ophthalmology, Rockwood Clinic Neuro-Ophthalmology, Spokane, Washington
Abstract Background: Susac syndrome (SS) classically presents with the clinical triad of retinal artery occlusion, sensorineural hearing loss, and encephalopathy and the neuroimaging triad of white matter lesions, deep gray matter lesions, and leptomeningeal disease. However, patients can present with an incomplete clinical or neuroimaging triads making diagnosis difficult in certain situations. A standard treatment paradigm also is lacking in this illness. It is important for neuro-ophthalmologists to recognize clinical and radiographic findings that are pathognomonic for this syndrome and have a basic understanding of the available treatment options. Evidence acquisition: Review of medical literature. Results: A definite diagnosis of SS is made when the clinical triad or the neuroimaging triad is present. There are numerous reports of 2 other imaging findings in this condition: arteriolar wall hyperfluorescence (AWH) on fluorescein angiography in retinal arterioles remote from retinal ischemia and central callosal lesions on MRI. Both of these imaging findings are diagnostic of SS. Gass plaques in retinal arterioles are almost always seen in the acute phase of the illness but are not pathognomonic for SS. The most common medications used in this syndrome are corticosteroids and intravenous immunoglobulin. A number of other medications have been used including mycopheolate, rituximab, azathioprine, and cyclophosphamide. Conclusions: In the absence of the clinical triad or magnetic resonance imaging triad for SS, AWH remote from retinal vascular injury and central callosal lesions are confirmatory of the diagnosis because they have never been described in any other condition. The presence of Gass plaques in retinal arterioles should strongly suggest the diagnosis. Despite the lack of clinical trial data, patients with SS must be treated promptly and aggressively. In more fulminant cases, addition of mycophenolate mofetil or rituximab is required, followed by cyclophosphamide when disease is refractory to other medications.
OCR Text Show
Publisher Lippincott, Williams & Wilkins
Date 2019-03
Type Text
Source Journal of Neuro-Ophthalmology, March 2019, Volume 39, Issue 1
Language eng
Rights Management © North American Neuro-Ophthalmology Society
Publication Type Journal Article
ARK ark:/87278/s68685wt
Setname ehsl_novel_jno
Date Created 2020-09-22
Date Modified 2021-05-06
ID 1595779
Reference URL https://collections.lib.utah.edu/ark:/87278/s68685wt
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