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Introduction A 37-year-old female was admitted to the neurology ward following a six-week history of recurrent cerebrovascular events in different territories, with some lesion burden in the corpus callosum on MRI, together with retinal and vestibular involvement, culminating in a diagnosis of Susac syndrome.Clinical course Following initial presentation she developed severe sequential bilateral sensorineural hearing loss. This was documented by Audiology as involving low and mid frequencies. Intratympanic steroid therapy was given by Ear, Nose and Throat, with limited effect.Despite the lack of visual symptoms at presentation, consultant ophthalmologist review of fundus fluorescein angiography showed bilateral branch retinal artery occlusions.Treatment with high-dose oral and intravenous steroid was initiated. Her disease continued to progress, and immunoglobulin therapy was commenced, escalating to cyclophosphamide on the advice of Rheumatology.Fertility-related side effects of cyclophosphamide therapy were discussed with Gynaecology: a gonadotrophin releasing hormone agonist was commenced to preserve ovarian function.She developed bradycardia with T-wave changes in anterior leads. Following electrocardiogram monitoring, without development of symptoms, further investigation was not advised by Cardiology.Conclusion This case illustrates the value of close multidisciplinary team working when managing multisystemic complications of Susac syndrome in a District General Hospital.l.sewell@doctors.org.uk