Case report: Susac syndrome-two ends of the spectrum, single center case reports and review of the literature

Vision Loss in an Infantryman With Complex Hearing Loss: Case Report and Review of Susac Syndrome

Susac syndrome can resemble various disorders resulting in a delayed or missed diagnosis and subsequent delays in treatment. Here, we present how successful consideration of patient history, symptoms, and ancillary testing led to prompt diagnosis and treatment of Susac syndrome by ophthalmologists. A 27-year-old active duty infantryman presented with sudden vision loss in the right eye during strenuous exercise after experiencing similar symptoms in the left eye 5 months earlier. The patient's medical history was notable for mixed conductive and sensorineural hearing loss, confounded by a history of concussions, syncope, frequent ear infections, tympanic membrane perforation requiring tympanoplasty, and loud noise exposures. Identification of branch retinal artery occlusions on fluorescein angiography and low-to-mid frequency hearing loss confirmed the diagnosis of Susac syndrome. The patient was immediately treated with high-dose oral prednisone and subsequently transitioned to rituximab infusions to preserve vision. Susac syndrome should be considered when a patient presents with vision loss, hearing deficits, and or cognitive changes, even if symptoms are separated by time and seemingly attributed to more common causes.

Integrated physiotherapy approach for susac syndrome: A comprehensive case study

INTRODUCTION

Susac's syndrome is a rare autoimmune disorder characterised by a triad of encephalopathy (brain dysfunction), branch retinal artery occlusion (loss of vision) and sensorineural hearing loss. This study presents the case of a patient undergoing intensive physiotherapy intervention following an injury, focusing on assessments such as volume and range of motion measurements, manual muscle tests, and pain intensity evaluations using various scales.

CASE DESCRIPTION

The patient, aged 17, initially presented with severe limitations in mobility, diagnosed with Susac syndrome. Requiring assistance to walk even short distances due to fear and insecurity. Through a structured physiotherapy program spanning several months, various assessments were conducted, including manual muscle tests and circumference measurements. Significant improvements were observed for muscle function, upper and lower limb circumferences, and performance in mobility tests.

OUTCOME

After 12 weeks of intensive therapy with a follow up for 4 months, progress was observed. Measurements of volume and range of motion, manual muscle test (MMT), Timed Up and Go test (TUG) and VAS scale were used as outcome variables. The patient transitioned from relying heavily on assistance for mobility to walking independently for 100 m. Muscle strength and endurance significantly improved, as evidenced by higher grades in manual muscle tests and reduced completion times in mobility assessments.

DISCUSSION

The presented case exemplifies the effectiveness of intensive physiotherapy intervention in improving mobility and functional outcomes in a patient with Susac Syndrome, a rare autoimmune disorder characterized by neurological manifestations. Despite the non-traumatic nature of the condition, Susac Syndrome poses significant challenges to mobility and quality of life due to its impact on the microvasculature of the brain, retina, and inner ear. The structured rehabilitation program, supported by comprehensive assessments including manual muscle tests and circumference evaluations, facilitated targeted interventions.

CONCLUSION

The observed improvements underscore the importance of tailored rehabilitation approaches in promoting recovery and independence in individuals with complex neurological conditions like Susac Syndrome. Further research is warranted to explore optimal rehabilitation strategies and long-term outcomes in this patient population.