Susac syndrome with transient inverted vision

Susac syndrome is a triad of subacute encephalopathy, branch retinal artery occlusions, and sensorineural hearing loss caused by autoimmune microangiopathy and infarction of the brain, retina, and cochlea.1 It primarily affects young women and usually remits within 2 years, but long-term sequelae occur.1 We report a patient with Susac syndrome who sought treatment for transient inverted vision. A 41-year-old woman had multiple episodes of alternating hemiparesis, lasting 30 minutes, occurring infrequently during a 3-month period. She then experienced the sudden perception of complete inversion of the visual world, with a sensation that her surroundings were upside down. This was accompanied by nausea, vertigo, left facial numbness, and dysarthria that lasted 3 hours. The visual illusion recurred twice, the latter two episodes accompanied by the illusion of looking through a kaleidoscope. There was no headache. Initial neurologic examination was normal except …