This article is from clinical ophthalmology auckland, n. Tersons syndrome is vitreous hemorrhage occurring consequent to subarachnoid hemorrhage. Terson syndrome or tersons syndrome is the occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage. Although litten reported vitreous haemorrhage in association with subarachnoid haemorrhage in 1881, it was terson who described the syndrome in 1900. We therefore designed a prospective singleblinded study to evaluate the validity of ocular ultrasound compared to the gold standard indirect funduscopy in the diagnosis of tersons syndrome. She was transported to a hospital where a possible subarachnoid hemorrhage was diagnosed radiologically. This syndrome can occur in the event of intracranial. Terson syndrome in aneurysmal subarachnoid hemorrhage. Blood may track along the subarachnoid space of the optic nerve sheath and enter the vitreous cavity through the optic nervehead. Garfinkle am, danys ir, nicolle da, colohan art, brem s. Terson syndrome is defined as intraocular hemorrhage associated with intracranial bleeding. Alternatively, the sudden spike in intracranial pressure may burst retinal vessels. Background and objectives lumbar epidural blood patch ebp is a commonly used procedure to treat postdural puncture headache.
Pdf this prospective trial was designed to evaluate the incidence of terson syndrome in patients suffering from subarachnoid hemorrhage, intracerebral. In one eye blood was suddenly spontaneously absorbed after four months. Vitreous hemorrhage of the eye can also occur in association with intracranial hemorrhage and elevated intracranial pressure icp. External photograph of right eye demonstrates blunted red reflex secondary to vitreous hemorrhage figure 2. Intraocular hemorrhage can be a subretinal, retinal, preretinal, subhyaloidal, or intravitreal hemorrhage. A case of tersonlike syndrome in a patient with viral. Intrathecal anesthesia after retrobulbar block, with. Pointofcare handheld ophthalmic ultrasound in the diagnosis and evaluation of raised intracranial pressure and. The combination of these features is known as terson syndrome subarachnoid hemorrhage has multiple grading systems, both clinically and radiologically based. Haemorrhage in tersons syndrome may be contained between the internal limiting membrane and retina or extend into.
We present a case of vision loss immediately following an ebp. Most cases of tersons syndrome involve patients who have had subarachnoid hemorrhages. Tersons syndrome is a frequent cause of visual loss following subarachnoid haemorrhage sah. Incidence of terson syndrome in treated subarachnoid.
The source of vitreous blood has never been established conclusively. Ct head scan revealed a tentorial acute subdural hemorrhage asdh and posterior globe hyperdensities suggestive of intraocular blood with a right posterior communicating artery aneurysm on cerebral angiography figure 1. Although early studies attempted to link this syndrome with aneurysms of the anterior communicating artery, statistical analysis has not correlated it with a specific aneurysmal location. Our objective was to determine whether imaging findings could be discovered that. This case shows an extensive subarachnoid hemorrhage with blood in the posterior globe. Ruptured aneurysm and terson syndrome in a 1monthold.
Vision restoration and lowered mortality can be achieved by early diagnosis and prognosis monitoring of intraocular bleeding through ophthalmological examinations and veps in patients with subarachnoid hemorrhage presenting cognitive impairment or visual field problems. Terson syndrome definition of terson syndrome by medical. Conclusions tersons syndrome occurs frequently following sah, although it is underreported. Subarachnoid haemorrhage sah associated with vitreous haemorrhage was first described by french ophthalmologist albert terson in 1900. Herein, we report a case of arn with atypical clinical features combined with tersons syndrome that we successfully treated by intravitreal ganciclovir injection. Terson syndrome caused by intraventricular hemorrhage. Tersons syndrome, subinner limiting membrane hemorrhage photographer shin jiyoung, eulji university, seoul imaging device fundus camera topcon trc 50 ex description fundus photograph of a 56yearold woman with a subilm hemorrhage. Introduction intraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as tersons syndrome and is an underestimated but common pathology. Terson syndrome ts is the presence of any intraocular hemorrhage, including vitreous, subhyaloid, intraretinal, or subretinal bleeding. A retrospective study of four patients with tersons syndrome from royal prince alfred hospital, sydney, was carried out. There were more than twice as many women as men, a finding consistent with the sex. A serious ophthalmological complication of an endoscopic third ventriculostomy that created an iatrogenic terson syndrome is described. A case of terson syndrome resulting with subarachnoid hemorrhage and right vitreous hemorrhage resulting from a left pericallosal artery aneurysm. We present the case of a 7monthold female infant who was found crying and limp.
Terson syndrome is defined as intraocular hemorrhage associated with. These frequently arise after rupture of an intracranial aneurysm, or dilated vessel in the brain. Download fulltext pdf download fulltext pdf download fulltext pdf download fulltext pdf download fulltext pdf download fulltext pdf terson syndrome and leukemia. Terson syndrome with persistent vitreous hemorrhage following. Terson syndrome can be an important marker to assess patients outcome. One does need to consider other causes of this condition in the differential diagnosis. Tersons syndrome has been associated with many conditions that increase intracranial pressure such as venous sinus thrombosis, moyamoya disease, leukemia, direct head trauma, and intraocular hemorrhage. Domeshaped posterior pole haemorrhages have been described in terson syndrome ts. We describe six eyes from three patients with terson syndrome. This syndrome can occur in the event of intracranial hemorrhage or. A case of terson syndrome in a 7monthold infant othon j.
View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Bedside optical coherence tomography for tersons syndrome screening in acute subarachnoid hemorrhage. Tersons syndrome refers to vitreous hemorrhage after intracranial hemorrhage, often from rupture of an aneurysm. External photograph of left eye demonstrates normal red reflex figure 3. Terson syndrome terson, vitreous, retinal, and subhyaloid hemorrhages associated with subarachnoid hemorrhage. Case report a 49yearold woman with idiopathic intracranial hypertension received an ebp for postdural puncture headache at an outside facility without fluoroscopic guidance and in the seated position. Tersons syndrome is a condition in which intracranial bleeding is associated with hemorrhage inside the eye. This study presents a rare case of terson syndrome with no cerebral hemorrhage secondary to tbi. In this syndrome, vitreous or retinal hemorrhage results from an abrupt rise in intracranial pressure, leading to retinal venous hypertension and intraocular hemorrhage. An abrupt increase in intracranial pressure icp is typically responsible for this type of intraocular hemorrhage. Unlimited viewing of the articlechapter pdf and any associated supplements and figures.
Acute vision loss secondary to epidural blood patch. Atypical acute retinal necrosis accompanied by tersons. Ab background tersons syndrome is intraocular hemorrhage ioh subsequent to subarachnoid hemorrhage sah. Acute retinal necrosis arn has characterized by panuveitis, vitritis, severe vasoocclusive vasculitis, and diffuse necrotizing retinitis. Terson syndrome and subarachnoid hemorrhage eccles. Ocular ultrasound as an easy applicable tool for detection. Strict guidelines for treatment have not been established by clinical studies. Pdf terson syndrome in subarachnoid hemorrhage, intracerebral. Three case reports of terson syndrome in babies, from 5 weeks to 7 months old, due to a ruptured angiodysplasia or an aneurysma have been published. The trip database provides clinical publications about evidence. Tersons syndrome following epidural saline injection. The occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage.
Terson syndrome with persistent vitreous hemorrhage following traumatic brain injury. The incidence of terson syndrome in patients with tsah was higher in those age under 40 than in those aged 40 or over. Pars plana vitrectomy for tersons syndromevisual outcome. Terson syndrome has been described most commonly in subarachnoid hemorrhages due to ruptured cerebral aneurysms. A 36yearold woman presented with acute severe headache and generalized tonicclonic seizures. The proposed mechanism of tersons syndrome is increased intracranial pressure that leads to dilation of the retrobulbar optic nerve and compression of the central retinal vein. Case report the patient, a 33yearold male miner, was hit in the right occipital region by a boulder while mining, three hours prior to admission to a local clinic. In approximately onethird of these eyes, a premacular accumulation of blood termed a hemorrhagic macular cyst hmc may be. The report by schultz et al entitled, longterm visual outcome in terson syndrome ophthalmology 1991. Assessment of visual acuity and physical disability pre and postvit rectomy using the snellen chart and the barthel index, respectively, was performed. Two reports appeared to be from the same cohort of patients.
Terson syndrome was originally defined as a vitreous hemorrhage arising from an aneurysmal subarachnoid hemorrhage sah. Terson syndrome can be caused by intracranial hemorrhage, subdural or epidural hematoma and severe brain injury but is extremely rare in intraventricular hemorrhage associated with moyamoya disease. Ophthalmologic assessment confirmed terson syndrome figure 2. Tersons syndrome refers to the occurrence of vitreous hemorrhage with subarachnoid hemorrhage sah, usually due to a ruptured cerebral aneurysm. Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. Pars plana vitrectomy was performed in one eye twelve weeks, and in four eyes six months after the acute event.
Purpose terson syndrome may be overlooked in the acute setting and often requires ophthalmologic intervention to prevent longterm visual loss. In the only published prospective case series of nonabuse instances of intracranial hemorrhage in children, 63 2% had intraocular hemorrhages. Suspected visual loss following sah should prompt a search for tersons syndrome by funduscopy, as its presence is an adverse prognostic factor. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Bedside optical coherence tomography for tersons syndrome. Three prospective studies satisfied the inclusion criteria. Tersons syndrome as a prognostic factor for mortality of.
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