We present a 38-year-old, right-handed, single Caucasian woman, who, at the age of 19, developed sudden onset of partial loss of sight bilaterally, which resolved without neurologic evaluation or intervention. Her episode of vision loss was immediately followed by symptoms of depression, including general malaise, sadness, and suicidal ideation. Over the following year, the patient continued to experience depressive episodes and occasional periods of grandiosity and paranoia. She was diagnosed with bipolar disorder at age 21 and successfully treated with the lowest doses of aripiprazole and sertraline. Of note, she described a family history of significant psychiatric illness, including depression and behavioral disturbances. Her psychiatric symptoms remained relatively stable until age 30, when she attempted suicide. Several months after her suicide attempt, she experienced a new onset of physiologic and neurologic symptoms, including dizziness, mild hearing loss, dysarthria, and ataxia, as well as cognitive symptoms, including difficulty with navigation, reduced concentration, and impaired reading comprehension. She was referred to a neurologist, and neuroimaging revealed white-matter changes, prominent lateral ventricles, and cerebellum volume loss. The patient's condition was ultimately characterized as a Susac-like syndrome manifesting as current spastic ataxia and previous episodes of retinal vein occlusion and vertigo.
Upon neuropsychological examination at age 38, the patient reported that she continues to have motor and cognitive symptoms, although they have not progressed for the past 5 years. She also denied any recurrence of significant psychiatric symptoms since her suicide attempt at age 30. Neuropsychological assessment revealed moderate impairments in basic and complex attention, nonverbal learning, and aspects of executive functioning, with language and memory representing significant strengths of the cognitive profile. Emotionally, she endorsed minimal symptoms of depression and anxiety.