226 - A Rare Case of Susac Syndrome in a Young Adult: Diagnosis, Management, and Outcomes Following Inpatient Rehabilitation

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

WS

William Schultze, DO

Resident
University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States

Co-Author(s)

JH

John A. Horton, III, MD

Attending Physician
UPMC
Pittsburgh, Pennsylvania, United States

Submitter(s)

WS

William Schultze, DO

University of Pittsburgh Medical Center
Pittsburgh, Pennsylvania, United States

Case Diagnosis: Susac Syndrome

Case Description: An independent 35-year-old female presented to the emergency department with abdominal pain, headaches, and dizziness. She was admitted to the hospital for further evaluation. On hospital day four, she developed bilateral lower extremity numbness and weakness, along with left upper extremity weakness. MRI of the brain and spine revealed diffusion restriction in the body of the corpus callosum and T2-T4 cord signal abnormalities. Inflammatory markers and antinuclear antibodies were highly elevated, prompting administration of 5 days of IV methylprednisolone. Lumbar puncture revealed elevated protein but was otherwise unremarkable. Neurology suspected Susac syndrome, who recommended an audiogram, which revealed bilateral sensorineural hearing loss, and fluoroscopic angiography once discharged from the hospital. The patient's neurological symptoms improved after treatment, and the patient was admitted to inpatient rehabilitation (IPR). She completed 10 days of IPR and was discharged home with full strength in her extremities at an independent level of assistance.

Discussions: Susac syndrome is an extremely rare autoimmune microangiopathy, characterized by encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss. This complete triad is rarely present simultaneously, often delaying diagnosis, and leading to misidentification as multiple sclerosis (MS). Headache is the most common neurologic symptom. Central callosal lesions are pathognomonic for Susac syndrome, and help distinguish this condition from MS. This patient also exhibited thoracic spinal cord involvement, a finding reported only once before in Susac syndrome. Early immunosuppressive treatment is critical to prevent irreversible deafness, blindness, and cognitive decline.

Conclusions: This rare case of Susac syndrome, initially presenting with headache, dizziness, and neurological deficits, highlights the diagnostic challenges associated with the condition. Given its potential to mimic multiple sclerosis, physiatrists should be familiar with its clinical and radiologic features to support timely and accurate diagnosis and intervention.