Atypical Presentation of Susac Syndrome in 55-Year-Old: From Unremarkable Stroke Workup to Rapid Diagnosis of "Snowball Strokes" and Successful Immunosuppressive Treatment.

We report the case of a 55-year-old right-handed female with a medical history of hypothyroidism and gastric bypass surgery. The patient initially presented with cognitive impairment, dizziness, and unsteady gait. Despite an unremarkable stroke workup, her symptoms progressed rapidly within 2 days, leading to subsequent admissions and a complex diagnostic journey revealing Susac syndrome-a rare autoimmune disorder affecting the brain's microvasculature, retina, and cochlea. The patient's treatment involved aggressive immunosuppression with corticosteroids, IVIG, mycophenolate, and cyclophosphamide. The patient responded well and had progressive improvement, with discharge to home. This case highlights the diagnostic challenges and management strategies for Susac syndrome.