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Triplett JD, Qiu J, O'Brien B, Gopinath S, Trewin B, Spring PJ, Shaffi M, Ip J, Chan F, Chen L, Wilson I, Muller C, Beadnall HN, Boggild M, Van der Walt A, Roxburgh R, Seery N, Kalincik T, Barnett MH, Parratt JDE, Reddel SW, Tsang B, Hardy TA. Diagnosis, differential diagnosis and misdiagnosis of Susac syndrome. Eur J Neurol 2022; 29:1771-1781. [PMID: 35262238 PMCID: PMC9314104 DOI: 10.1111/ene.15317] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 01/25/2022] [Indexed: 11/28/2022]
Abstract
Background and purpose Susac syndrome (SuS) is an inflammatory condition of the brain, eye and ear. Diagnosis can be challenging, and misdiagnosis is common. Methods This is a retrospective review of the medical records of 32 adult patients from an Australasian cohort of SuS patients. Results An alternative diagnosis prior to SuS was made in 30 patients (94%) with seven patients receiving two or more diagnoses. The median time to diagnosis of SuS was 3 months (range 0.5–100 months). The commonest misdiagnoses were migraine in 10 patients (31%), cerebral vasculitis in six (19%), multiple sclerosis in five (16%) and stroke in five (16%). Twenty‐two patients were treated for alternative diagnoses, 10 of whom had further clinical manifestations prior to SuS diagnosis. At presentation seven patients (22%) met criteria for definite SuS, 19 (59%) for probable SuS and six (19%) for possible SuS. Six patients (19%) presented with brain–eye–ear involvement, 14 with brain–ear (44%), six with brain–eye (19%) and six (19%) with only brain involvement. In patients with the complete triad of symptoms the median delay to diagnosis was 3 months (range 1–9 months) compared to 5.25 months (range 0.5–100 months) for patients with encephalopathy and ocular symptoms at presentation. Conclusions Susac syndrome patients are frequently misdiagnosed at initial presentation, despite many having symptoms or radiological features that are red flags for the diagnosis. Delayed diagnosis can lead to patient morbidity. The varied ways in which SuS can present, and clinician failure to consider or recognize SuS, appear to be the main factors leading to misdiagnosis.
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Affiliation(s)
- James D Triplett
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Jessica Qiu
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Billy O'Brien
- Department of Neurology, Gosford Hospital, Gosford, NSW, Australia
| | - Sumana Gopinath
- Department of Neurology, Campbelltown Hospital, Sydney, NSW, Australia
| | - Benjamin Trewin
- Department of Neurology, Campbelltown Hospital, Sydney, NSW, Australia
| | - Penelope J Spring
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | | | - Jerome Ip
- Section of Neurology, Sydney Adventist Hospital, Sydney, NSW, Australia
| | - Fiona Chan
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Luke Chen
- Brain & Mind Centre, University of Sydney, NSW, Australia.,Department of Neurology, The Alfred Hospital, Monash University, Melbourne, Vic, Australia
| | - Ian Wilson
- Department of Neurology, Cairns Hospital, Cairns, Qld, Australia
| | - Claire Muller
- Department of Neurology, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
| | - Heidi N Beadnall
- Brain & Mind Centre, University of Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Mike Boggild
- Department of Neurology, Townsville Hospital, Townsville, Qld, Australia
| | - Anneke Van der Walt
- Department of Neurology, The Alfred Hospital, Monash University, Melbourne, Vic, Australia
| | - Richard Roxburgh
- Department of Neurology, Auckland City Hospital, Auckland, New Zealand
| | - Nabil Seery
- MS Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia
| | - Tomas Kalincik
- MS Centre, Royal Melbourne Hospital, University of Melbourne, Melbourne, Vic, Australia.,Department of Medicine, University of Melbourne, Melbourne, VIC, Australia
| | - Michael H Barnett
- Brain & Mind Centre, University of Sydney, NSW, Australia.,Department of Neurology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - John D E Parratt
- Department of Neurology, Royal North Shore Hospital, Sydney, NSW, Australia
| | - Stephen W Reddel
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia
| | - Benjamin Tsang
- Department of Neurology, Sunshine Coast Hospital, Sunshine Coast, Qld, Australia
| | - Todd A Hardy
- Department of Neurology, Concord Hospital, University of Sydney, NSW, Australia.,Brain & Mind Centre, University of Sydney, NSW, Australia
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