115 SUSAC’S SYNDROME: LIMITATIONS OF CLASSICAL TRIAD AND FUNDOSCOPY IN DIAGNOSIS. WHAT CAN

Background Susac’s syndrome is described as a triad of encephal-opathy, retinopathy, and hearing loss. We describe a case where fluorescein angiography was required to demonstrate the retinop-athy which was not detectable by indirect opthalmoscopy. Case Report A 22 year old lady presented on the background of two admissions to hospital for abdominal pain, nausea and vomit-ing over the preceding 8 months. The presentation to neurology was precipitated by further episodes of nausea and vomiting accompanied by agitated and sometimes bizarre behaviour, includ-ing a delusion of living in a foreign country. On examination she was encephalopathic with a score on the revised Addenbrookes cognitive examination (ACE–R) of 66/100, with particular deficit on attention, memory, and verbal fluency. Visual fields to confron-tation and colour vision were normal. Visual acuity was 6/18 (right) and 6/9 (left). Retinal vasculature appeared normal on indirect opthalmoscopy. She had a mild upper motor neuron left sided facial weakness. In her limbs there was normal tone, power, and reflexes, but plantar responses were extensor bilat-erally. CSF results at presentation were: White cell count=16/cc, protein=1.88 g/dl, glucose=normal, CSF angiontensive convert-ing enzyme (ACE) =normal, lactate=normal, viral PCR including JC virus=normal. There was a polyclonal increase in CSF gamma globulin. MRI of brain showed a number of T2 white matter hyperintensitiesaffecting the deep white matter, periventricular regions, and genu and splenium of the corpus callosum. VERS showed delayed P100 responses bilaterally. FBC showed an eosino-philia (1.8×10.9). The following investigations were normal: vitamin B12, folate, blood film,urine toxicology, U&Es, LFTS, CRP, ammonia, protein electrophoresis, plasma and urine tota