Subarachnoid hemorrhage-negative Terson syndrome after intracranial artery treatment with a flow diverter device

Abstract

Purpose To report a case of subarachnoid hemorrhage-negative Terson syndrome following intracranial artery treatment with flow diverter stents. Observations A 40-year-old Asian woman presented with floaters in her right eye after treatment of an intracranial aneurysm with flow diverter stents. Vitreous hemorrhage and sub-inner limiting membrane (sub-ILM) hemorrhage were present in her right eye. On fluorescein angiography, contrast perfusion and vascular occlusion were not noted. Magnetic resonance imaging (MRI) did not show any evidence of subarachnoid hemorrhage (SAH). We hypothesize that the bleeding was due to Terson syndrome associated with intracranial treatment with the flow diverter stents. During follow-up, the vitreous hemorrhage and sub-ILM hemorrhage disappeared, and the floaters in her vision improved. Conclusions and Importance This is the first reported case of vitreous hemorrhage and sub-ILM hemorrhage that should be considered to be Terson syndrome, after flow diverter stents treatment in the absence of SAH.

Multilayered macular hemorrhages as an unusual complication of transorbital neuroendoscopic surgery

“… 1 , 15 , 16 However, the definition of Terson syndrome has shifted over the decades, and is now commonly used to describe the association of an acutely elevated ICP with intraocular hemorrhages, even in the absence of intracranial hemorrhage . 2 , 3 , 4 , 5 Here, we present a Terson-like clinical picture of multilayered hemorrhage at the posterior pole, as a complication of transorbital neuroendoscopic surgery, occurring in the absence of either elevated ICP or intracranial hemorrhage.…”

“… 1 Notably, similar ophthalmic presentations have been reported in the absence of intracranial hemorrhage, but in association with elevated intracranial pressure (ICP), suggesting that an acute rise in ICP may be involved in the pathogenesis of Terson syndrome. 2 , 3 , 4 , 5 However, the origin of intraocular blood and the role of ICP fluctuation in the pathophysiology of Terson syndrome remains a matter of debate. 6 …”

Terson Syndrome: A Review of the Literature

“…There are also reports of Terson syndrome associated with lumbosacral myelomeningocele, spinal subarachnoid hemorrhage, arteriovenous malformation, carotid artery occlusion, cortical venous sinus thrombosis, and cerebrovascular disorders like Moyamoya disease 14–20 . Iatrogenic causes include epidural injections, flow diverter stent treatment of aneurysms, lumbar epidural blood patches, endoscopic third ventriculostomy, ventriculoscopy, and intraarterial angiography 21–27 …”

“…[14][15][16][17][18][19][20] Iatrogenic causes include epidural injections, flow diverter stent treatment of aneurysms, lumbar epidural blood patches, endoscopic third ventriculostomy, ventriculoscopy, and intraarterial angiography. [21][22][23][24][25][26][27]…”