Papo T, Klein I, Sacré K, Doan S, Bodaghi B, Aubart-Cohen F
Service de médecine interne, hôpital Bichat, 46, rue Henri-Huchard, 75018 Paris, France.
Rev Med Interne. 2012 Feb;33(2):94-8. doi: 10.1016/j.revmed.2011.11.002. Epub 2011 Dec 20.
Susac syndrome is a mysterious vasculopathy affecting brain, retina and inner ear in young women. Main features of the disease are increasingly recognized: subacute encephalopathy often mimicking psychosis and frequently heralded with unusual ophthalmic migraine; frequent subclinical meningitis; brain MRI with multiple and bilateral white and gray matter nuclei lesions, with prominent involvement of corpus callosum; bilateral involvement of central retina artery branches, not only with occlusions but also with peculiar leakage of fluorescein through arteriolar walls on late stages of angiography; non-specific bilateral cochleovestibular symptoms with audiogram showing perception hypoacousia that predominates on low frequencies. Outcome, prognosis, pathogenesis and a rational basis for treatment are discussed in this review. A key message for the clinician should be to perform brain MRI, audiogram and retinal angiography whatever the mode of entry, in order not to miss one (or two) features of this syndrome triad.
Susac综合征是一种影响年轻女性大脑、视网膜和内耳的神秘血管病变。该疾病的主要特征越来越受到认可:亚急性脑病常类似精神病,且常伴有不寻常的眼科偏头痛先兆;频繁出现亚临床脑膜炎;脑部磁共振成像显示双侧多发白质和灰质核病变,胼胝体受累明显;视网膜中央动脉分支双侧受累,不仅有阻塞,在血管造影后期还出现荧光素通过小动脉壁的特殊渗漏;非特异性双侧耳蜗前庭症状,听力图显示低频为主的感知性听力减退。本文综述讨论了其结局、预后、发病机制及合理的治疗依据。临床医生的关键信息是,无论何种就诊方式,都应进行脑部磁共振成像、听力图和视网膜血管造影,以免遗漏该综合征三联征的一个(或两个)特征。