A 53-year-old man with abrupt hearing loss Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology.

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A 53-year-old man with abrupt hearing loss Teaching NeuroImages Neurology Resident and Fellow Section © 2013 American Academy of Neurology

Vignette A 53-year-old man presented with sudden hearing loss, followed by a four week course of recurrent vertigo, headaches, and ataxia. Brain MRI revealed multiple punctate ischemic foci on corpus callosum. Cerebral angiogram and echocardiogram were unremarkable. Oliveira et al. © 2013 American Academy of Neurology

Imaging Figure 1 Oliveira et al. © 2013 American Academy of Neurology

Snowball - like lesions with sudden hearing loss Susac’s syndrome was diagnosed following the findings of branch retinal artery occlusion from fluorescein angiography. Distinguishing MRI findings consist of snowball-like lesions located in the center of the corpus callosum, indicative of tiny pre-capillary arteriole occlusion. (1) Small arteriole involvement explains why arteriography is normal in the majority of cases. (2) Case underlies the importance of performing fluorescein angiography when encountering unexplained hearing loss and snowball-like lesions. Oliveira et al. © 2013 American Academy of Neurology