I read with great interest the article "Microangiopathy of the Inner Ear, Retina, and Brain (Susac syndrome)" by Ayache et al.1 The clinical findings (impaired vision and gait disturbance) of this syndrome, as well as the imaging findings, are similar to those of multiple sclerosis (MS).
Multiple sclerosis frequently involves the brainstem and cerebellar peduncles, as in the case reported by Ayache and colleagues. The middle cerebellar peduncle is a particularly common site for demyelinitating plaques. One or more small lesions within the pons and the brachium pontis in a young patient should also suggest the possibility of MS. Multiple sclerosis must also be considered in the differential diagnosis of multiple enhancing nodules after contrast injection on T1-weighted images.
Sirikci A. Susac Syndrome and Multiple Sclerosis. Arch Otolaryngol Head Neck Surg. 2001;127(4):468. doi:10.1001/archotol.127.4.468