Ocular Ultrasound as an Easy Applicable Tool for Detection of Terson's Syndrome after Aneurysmal Subarachnoid Hemorrhage

Abstract

IntroductionIntraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as Terson's syndrome and is an underestimated but common pathology. We therefore designed a prospective single-blinded study to evaluate the validity of ocular ultrasound compared to the gold standard indirect funduscopy in the diagnosis of Terson's syndrome.Material and MethodsFifty-two patients (104 eyes in total) suffering from aneurysmal subarachnoid hemorrhage were enrolled in this study. Two investigators independently performed a single-blinded ocular ultrasound using a standard intensive care ultrasound system to detect an intraocular hemorrhage. Indirect funduscopy following iatrogenic mydriasis served as the gold standard for confirmation or exclusion of an intraocular hemorrhage. Statistical analyses were performed to evaluate the sensitivity and specificity, positive and negative predictive values of the method as well as the learning curve of ocular ultrasound.ResultsIndirect funduscopy detected Terson's syndrome in 11 of 52 (21.2%) respectively in 21 of 104 (20.2%) eyes in patients suffering from subarachnoid hemorrhage. Sensitivity and specificity increased with the number of ocular ultrasound examinations for both investigators, reaching 81.8% and 100% respectively. Positive and negative predictive values were different for both investigators (63.6% vs. 100% positive and 100% vs. 95.7% negative) but were both correlated to the amount of intraocular hemorrhage. A low Glasgow Coma scale (p = 0.015) and high Hunt & Hess grade (p = 0.003) was associated with a higher rate of Terson's syndrome.ConclusionsOcular ultrasound using standard ultrasound equipment has been confirmed as a reliable, easy-to-handle bedside screening tool for detecting Terson's syndrome. Nevertheless funduscopy remains the gold standard to detect Terson's syndrome.

Terson's Syndrome: Diagnostic Comparison of Ocular Sonography and CT

“…Our results match with data published by Czorlich et al, recently . In a similar study they investigated the validity of ocular sonography compared to funduscopy in the diagnosis of SAH‐related OH.…”

“…Our results match with data published by Czorlich et al, recently. 24 In a similar study they investigated the validity of ocular sonography compared to funduscopy in the diagnosis of SAH-related OH. Accuracy for dense VH was between 89% and 95% and between 82% and 85% for any OH, respectively.…”

“…The sonographic evaluation of vitreoretinal diseases with VH has become a well‐established tool over the past five decades . Recently, one study described its usefulness in acute SAH for the first time …”

“…[20][21][22][23] Recently, one study described its usefulness in acute SAH for the first time. 24 This prospective study investigates the diagnostic accuracy of ocular sonography in comparison with standard head CT for diagnosing OH in acute SAH. Neurosurgery of the University Hospital Freiburg.…”

Bedside optical coherence tomography for Terson’s syndrome screening in acute subarachnoid hemorrhage: a pilot study

“…21 TS is easily diagnosed by funduscopy and/or ocular ultrasonography/CT in a minority of patients who present with vitreous hemorrhages (approximately 4% of cases). 5 However, most frequently TS manifests as retinal, preretinal, or subretinal hemorrhages; 18 retinal detachments; 2,34 and macular holes, 28,29 which may remain undetected by these techniques. 23,24,30 Other challenges to TS diagnosis involve lack of cooperation with the ophthalmological examination in patients with a decreased consciousness, or speech impairment.…”