Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension

Abstract

✓ The eyes of 23 patients with sudden intracranial hypertension were studied at post-mortem. Intraocular hemorrhage had occurred in 37% and optic nerve sheath hemorrhage in 87%. Expansion of the optic nerve sheath, particularly the fusiform retrobulbar portion, was a consistent finding. The subdural space of the optic nerve sheath bore the brunt of the hemorrhage which sometimes communicated with perivascular intradural hemorrhages. Optic nerve sheath hemorrhage is shown to result from rupture of dural and bridging vessels of the optic nerve sheath; this we conclude is subsequent to optic nerve sheath dilatation caused by the transmission of intracranial pressure through the subarachnoid communication between the optic nerve sheath and the intracranial cavity. Intraocular hemorrhage is the result of retinal venous hypertension and rupture brought on by obstruction of both the central retinal vein and the retinochoroidal anastomosis.

Significance of Fundal Hemorrhage in Predicting the State of the Patient with Ruptured Intracranial Aneurysm

“…According to this view, the hemorrhage of the optic sheath might be the first phase of the development of FH. Muller and Deck [1974] have supported this view by finding hemorrhage of the op tic sheath in 87% of their cases with sud denly increased intracranial pressure. In the next phase, the hemorrhage of the optic sheath might compress the retinochorioidal anastomosis and the partial obstruction of venous outflow might lead to the rupture of veins in the retina.…”

Intraocular Hemorrhage in Sudden Increased Intracranial Pressure (Terson Syndrome)

“…The hypothesis mostly ac cepted actually is the one of Muller and Deck [1974]; they think these hemorrhages result as a consequence of the obstruction of the central retinal vein at the level of the retinochoroidal anastomosis, produced by the diffusion of CSF in the optic nerve sheath through the subarachnoid communi cation in the optic canal with the intracranial cavity.…”

Prevalence of Retinal Hemorrhages in Pediatric Patients After In-hospital Cardiopulmonary Resuscitation: A Prospective Study

“…Second, the increased central venous pressure can result in an elevated intracranial pressure that has been suggested to cause retinal hemorrhages. 16,17 However, there is little direct evidence that the increased intrathoracic pressures with chest compressions during CPR result in retinal hemorrhages. Furthermore, no large scale prospective studies have been done to evaluate the association of retinal hemorrhages after chest compressions when the etiology of the arrest is definitively nontraumatic.…”