Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: predisposing factors and prognostic significance

Abstract

Terson hemorrhage constitutes a common SAH-associated complication. Its incidence is increased in patients with low GCS and high WFNS scores, and high Hunt and Hess and Fisher grades. Its presence is associated with increased mortality and morbidity rates.

25G compared with 20G vitrectomy under Resight non-contact wide-angle lenses for Terson syndrome

“…Terson syndrome now encompasses any intraocular hemorrhage associated with intracranial hemorrhage and elevated intracranial pressures (2)(3)(4), which often results in significant morbidity and subsequent decreased quality of life. Vitrectomy has been proposed to have a role in treating Terson syndrome, and numerous studies have reported good visual recovery following surgery (5)(6)(7)(8).…”

Terson's Syndrome

“…Terson's syndrome is reported to occur in 2.6 to 27% of patients following SAH, depending on how carefully the diagnosis is sought 8 . Patients with subhyaloid hemorrhage generally complain of scotoma as compared to those with vitreous hemorrhage, who report blurred vision and floaters.…”

“…Patients with subhyaloid hemorrhage generally complain of scotoma as compared to those with vitreous hemorrhage, who report blurred vision and floaters. Typically, patients with TS have a worse clinical SAH grade on admission 6,8 , likely in part due to the sudden increase in ICP required to cause intraocular hemorrhage. The acute increase in ICP immediately following SAH may last only a few minutes 9 , and the anterior communicating artery location adjacent to the optic nerve sheath may allow for a more focal increase in ICP without generalized cerebral injury.…”

“…In this case, our patient suffered a significant intraocular hemorrhage, with visual loss his sole presenting complaint other than headache. Most vitreous hemorrhages due to TS resolve spontaneously, with the majority of patients making good recovery of vision 8,10 . However, delayed clot resorption may be associated with complications such as epiretinal membrane formation and retinal detachment and permanent visual loss 11 .…”

“…However, delayed clot resorption may be associated with complications such as epiretinal membrane formation and retinal detachment and permanent visual loss 11 . After a six month trial of conservative management, surgical drainage of the hematoma is generally recommended, with good outcomes in the majority of cases 6,8 .…”