Intraocular Hemorrhage in Sudden Increased Intracranial Pressure (Terson Syndrome)

Diaz, Antonio Gutierrez; Carmena, Javier Jimenez; Martin, Felipe Ruano; López, Pedro Díaz; Casado, Maria Jesus Muñoz

doi:10.1159/000308887

Cited by 22 publications

(7 citation statements)

References 3 publications

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“…Of note, the hemorrhage pattern observed in Terson syndrome, which is thought to arise from a sudden increase in ICP due to intracranial hemorrhage, is primarily that of preretinal and vitreous hemorrhage and rarely resembles the patterns of hemorrhage seen in AHT. [23][24][25][26][27] The exclusion of patients too unstable to allow time for OP to be measured might bias the prevalence estimate of RH downward if sicker patients are assumed to be more likely to have RH, but the validity of this assumption is not clear, and there is no reason to suspect that the RH patterns associated with elevated ICP would differ in such children. Finally, in a small minority of cases, the eye examination preceded or followed the LP by up to 96 hours, a time period during which intraretinal hemorrhages might begin to resolve.…”

Section: Figurementioning

confidence: 99%

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Binenbaum¹,

Rogers

Forbes³

et al. 2013

Pediatrics

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WHAT'S KNOWN ON THIS SUBJECT: Retinal hemorrhage (RH) is an important sign of pediatric abusive head trauma. Raised intracranial pressure (ICP) is sometimes proposed as an alternate cause of RH in children being evaluated for possible child abuse.WHAT THIS STUDY ADDS: Nontraumatic, markedly elevated ICP rarely causes RH in children. When it does, RH are superficial intraretinal and located adjacent to a swollen optic nerve head. This pattern does not match the widespread pattern seen in abusive head trauma. abstract OBJECTIVE: Raised intracranial pressure (ICP) has been proposed as an isolated cause of retinal hemorrhages (RHs) in children with suspected traumatic head injury. We examined the incidence and patterns of RHs associated with increased ICP in children without trauma, measured by lumbar puncture (LP). METHODS:Children undergoing LP as part of their routine clinical care were studied prospectively at the Children' s Hospital of Philadelphia and retrospectively at Nationwide Children' s Hospital. Inclusion criteria were absence of trauma, LP opening pressure (OP) $20 cm of water (cm H 2 O), and a dilated fundus examination by an ophthalmologist or neuro-ophthalmologist. RESULTS:One hundred children were studied (mean age: 12 years; range: 3-17 years). Mean OP was 35 cm H 2 O (range: 20-56 cm H 2 O); 68 (68%) children had OP .28 cm H 2 O. The most frequent etiology was idiopathic intracranial hypertension (70%). Seventy-four children had papilledema. Sixteen children had RH: 8 had superficial intraretinal peripapillary RH adjacent to a swollen optic disc, and 8 had only splinter hemorrhages directly on a swollen disc. All had significantly elevated OP (mean: 42 cm H 2 O). CONCLUSIONS:Only a small proportion of children with nontraumatic elevated ICP have RHs. When present, RHs are associated with markedly elevated OP, intraretinal, and invariably located adjacent to a swollen optic disc. This peripapillary pattern is distinct from the multilayered, widespread pattern of RH in abusive head trauma. When RHs are numerous, multilayered, or not near a swollen optic disc (eg, elsewhere in the posterior pole or in the retinal periphery), increased ICP alone is unlikely to be the cause. Pediatrics 2013;132:e430-e434 AUTHORS:

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Section: Figurementioning

confidence: 99%

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Binenbaum¹,

Rogers

Forbes³

et al. 2013

Pediatrics

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“…Intraocular haemorrhage seems to be associated with more severe subarachnoidal haemorrhage: 89% of patients with intraocular haemorrhage had a history of coma, compared to 46% of those without intraocular haemorrhage (Roux et al 1991;Kuhn et al 1998). The presence of intraocular haemorrhage is linked to a higher morbidity, whereas it is no longer associated with an increased mortality rate (Gutierrez Diaz et al 1979;Roux et al 1991). The precise pathophysiological mechanism of disease has not been agreed on fully (Castren 1963;Meier & Wiedemann 1996;Ogawa…”

Section: Introductionmentioning

confidence: 99%

Outcome indicators for vitrectomy in Terson syndrome

Garweg¹,

Koerner

2009

Acta Ophthalmologica

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. Purpose: There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. Methods: In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. Results: Thirty‐seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best‐corrected visual acuity (BCVA) at first and last presentation was 0.07 ± 0.12 and 0.72 ± 0.31, respectively. Thirty‐five eyes (79.5%) achieved a postoperative BCVA of ≥ 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of ≥ 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 ± 0.27 compared to 0.66 ± 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 ± 0.24 compared to 0.60 ± 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. Conclusion: Ninety‐eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery.

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“…-7 (2) --Diaz 16 19 -2 (11) 0 of 2 5 of 17 Shinoda 17 172 ( estimate may not reflect the true prevalence of this clinical feature, so the prognostic significance may also be inaccurate.…”

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confidence: 99%

A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage

McCarron

2004

Journal of Neurology, Neurosurgery & Psychiatry

125

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Intraocular Hemorrhage in Sudden Increased Intracranial Pressure (Terson Syndrome)

Abstract: We examined 19 cases with SAH, 4 of which presented intraocular hemorrhages (retinal, subhyaloid and in vitreous). The mortality rate was 50% when the intraocular hemorrhages were present compared to 20% when they were absent.

Cited by 22 publications

References 3 publications

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Patterns of Retinal Hemorrhage Associated With Increased Intracranial Pressure in Children

Outcome indicators for vitrectomy in Terson syndrome

A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage

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