Jul 31, 2018
A young woman presents with migraine-like headaches, black spots
in her vision and emotional lability. Think you know the diagnosis?
You may be surprised – this medical mystery is not what it seems.
In this episode, learn more about this rare diagnosis, and gain
clinical insight from neurologist Devon Conway,
MD, and ophthalmologist Arthi Venkat,
- Intro :11
- A 24-year-old woman presents with gradual worsening of a
migraine-like headache accompanied by nausea
- Description of symptoms :37
- ER visit 1:23
- Onset of new symptoms 1:44
- Second ER visit 2:11
- Outpatient MRI findings 2:28
- Lumbar puncture findings 2:50
- Patient is admitted to hospital
- Second MRI findings 4:16
- Ophthalmology consult and results of fluorescein angiography
- Audiogram is ordered 5:17
- Case summary 5:40
- What is the most likely diagnosis?
- Triad of Susac syndrome 6:27
- Remember: This is not a vasculitis
- History of Susac syndrome 7:40
- CNS manifestations of the Susac triad
- Consult with Devon Conway, MD 10:13
- Flare signals for non-radiologists/neurologists 11:05
- Anything specific that says “demyelinating” on MRI?
- Distinguishing the lesions in this case from those of MS
- Neurology work-up approach to this type of case
- The utility of lumbar puncture in this situation
- About ADEM (acute disseminated encephalomyelitis)
- Ocular manifestations of Susac syndrome
- Consult with Arthi Venkat, MD 23:17
- Ophthalmology differential in a patient with intermittent
vision loss in various fields of vision
- Overview of branch retinal artery occlusions
- Difference between branch retinal artery occlusions and other
ophthalmologic presentations common to rheumatologists
- How the ophthalmologic exam helps differentiate MS from Susac
- Overview of sensorineural hearing loss in Susac syndrome
- Do we know for sure this is an autoimmune disease?
- Aggressive immunosuppression seems to halt the progression of
- What are treatment options?
- What do we know about long-term outcomes?
- Who takes care of these patients?
- Treatment, outcome of this patient
- Episode/case summary 38:20
Devon Conway, MD, is a staff neurologist at
Cleveland Clinic’s Mellen Center for Multiple Sclerosis.
Arthi Venkat, MD, is a retinal and uveitis
specialist at Cole Eye Institute at Cleveland Clinic.
We’d love to hear from you! Send your comments/questions to
Aubart-Cohen F, et
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