Terson's syndrome presenting as an ophthalmic emergency

Abstract

ABSTRACT.Purpose: To report an unusual case of Terson's syndrome caused by a ruptured intracranial aneurysm presenting as an ophthalmic emergency with visual loss, without any neurological features at the time of presentation. Methods: Case report. A 38-year-old man was referred to the eye emergency department with sudden loss of vision in both eyes. Vitreous haemorrhage was noted in both eyes. There was no history of loss of consciousness or headaches and no signs of meningeal irritation at presentation. The patient subsequently developed progressive neck stiffness and headache. Results: Neuro-imaging studies revealed a subarachnoid haemorrhage resulting from a ruptured carotid-ophthalmic artery aneurysm. Conclusions: It is important to consider Terson's syndrome, a potentially lifethreatening condition, in any patient presenting with bilateral vitreous haemorrhage. Some patients may not show any headache, neurological deficits or signs of meningeal irritation at presentation but may develop them later on.

Terson Syndrome with Roth Spot Resembling Features and Third Nerve Palsy without Radiologically Diagnosed Subarachnoid Haemorrhage

“…[6] Nevertheless, there have been 2 published cases where Terson's syndrome occurred without any neurological signs. [11,12] The presence of Roth spot resembling features in our case suggested the possibility of underlying haematological disease. The presence, however, of a pupil-involving third nerve palsy constituted a neurosurgical emergency due to the possibility of the presence of an enlarging intracranial aneurysm.…”

An unusual presentation of Terson's syndrome

“…Atypical presentations of Terson's syndrome have been described in past. [8][9][10] In these cases however, there was associated seizure activity or meningeal irritation near the time of visual loss. This case is unique in that the patient had no neurological symptoms until collapse.…”

Terson’s Syndrome

“…In rare cases, the patient may present with visual loss in the absence of headache as the initial complaint, followed by subsequent detection of SAH. Two cases of this have been reported, where the patients subsequently deteriorated and one died [25,26].…”