Terson's syndrome, the current concepts and management strategies: A review of literature

Aboulhosn, Rabii; Raju, Bharath; Jumah, Fareed; Majmundar, Neil; Prenner, Jonathan L.; Matin, Tariq; Roychowdhury, Sudipta; Singla, Amit; Khandelwal, Priyank; Nanda, Anil; Gupta, Gaurav

doi:10.1016/j.clineuro.2021.107008

Cited by 23 publications

(20 citation statements)

References 63 publications

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“…Intraocular hemorrhage has been demonstrated after aneurysmal subarachnoid hemorrhage as part of a condition known as Terson's syndrome. 8 We speculate as to whether contributions of birth trauma, aneurysmal subarachnoid hemorrhage, and underlying vascular instability from ANKRD17 pathogenicity may play a role in the development of commotio retinae. This patient demonstrated encephalomalacia in the cerebral hemisphere contralateral to the site of aneurysm rupture, and we speculate this may have been the result of delayed cerebral ischemia arising from cerebrovascular vasospasms after aneurysmal subarachnoid hemorrhage.…”

Section: Discussion/conclusionmentioning

confidence: 94%

Neonatal Aneurysm Rupture in a Child with a De Novo Variant to ANKRD17

Silverstein

Kuwabara

Appavu

2022

Child Neurology Open

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Ankyrin repeat domain 17 (ANKRD17) is postulated to play a role in the integrity of blood vessels and has been reported to be associated with developmental delays, epilepsy, and growth restriction. Whereas ANKRD17-deficient mice have been demonstrated to experience catastrophic hemorrhages, vascular malformations have not been reported in human patients with pathogenic variants to ANKRD17. We report a term male neonate with a heterozygous de novo variant to ANKRD17 (ANKRD17; c6988 C > G, P.[P2330a]) who experienced subarachnoid hemorrhage from a ruptured aneurysm involving the left middle cerebral artery. He experienced acute symptomatic seizures and required clipping of his aneurysm at 35 days of life, later progressing to developing multifocal drug-resistant epilepsy. To our knowledge, this case represents the first report of a cerebrovascular malformation from a patient with ANKRD17. Further work is needed to investigate whether pathogenic variants to ANKRD17 can lead to cerebral aneurysms or other cerebrovascular malformations in children.

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Section: Discussion/conclusionmentioning

confidence: 94%

Neonatal Aneurysm Rupture in a Child with a De Novo Variant to ANKRD17

Silverstein

Kuwabara

Appavu

2022

Child Neurology Open

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“…However, early diagnosis allows for the identification of patients who are more likely to require surgery, serial evaluations to assess the evolution of the haemorrhages and the implementation of conservative measures, such as limiting physical activity and adopting a semi-recumbent position to allow for settling of the blood, improved vision and more thorough fundoscopic examination. 20 A longer period of haemorrhage increases the risk of iron toxicity, the formation of pre-retinal membranes, and the development of retinal atrophy in subretinal bleeding. 21–23…”

Section: Discussionmentioning

confidence: 99%

Terson Syndrome – Clinical Presentation, Management, and Visual Outcomes in a Tertiary Centre

Lima-Fontes

Leuzinger-Dias

Rodrigues

et al. 2023

OPTH

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Purpose The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal. Patients and Methods A single-centre retrospective study was performed, based on the survey review of the medical records of every consecutive patient diagnosed with Terson syndrome and followed from January 2018 to August 2021. The change in best-corrected visual acuity (BCVA) from baseline to the final evaluation was the primary outcome. Results Fifteen eyes from 8 patients (50% female) were included. The mean age at diagnosis was 55±7 years. The neurological event was traumatic brain injury in 37.5% (n=3) and subarachnoid haemorrhage in 62.5% of the patients (n=5). Bilateral intraocular haemorrhage occurred in 875% (n=7) of the patients. Vitreous and preretinal haemorrhages occurred each in 66.7% (n=10), intraretinal in 30% (n=3) and subretinal in 13.3% (n=2) of the eyes. In 40% of the eyes (n=6), spontaneous resolution of intraocular haemorrhage occurred, while PPV was performed in the remaining 60% (n=9). Ocular haemorrhage detection occurred 58.47 ± 40.94 days after the neurological event (range 11 to 121 days). Baseline BCVA was 1.11 ± 1.01 logMAR and improved to 0.32 ± 0.69 logMAR in the follow-up period (p=0.004). A positive correlation was found between initial and final BCVA (Spearman’s rho = 0.643, p=0.01). Baseline BCVA of eyes undergoing PPV was lower than of those conservatively managed (1.84±0.72 vs 0.20±0.28 logMAR, p<0.001). However, there were no statistically significant differences in final BCVA after surgery or observation (0.56 ± 0.90 vs 0.04 ± 0.04 logMAR, p=0.149). Longer periods between the neurological and the ophthalmological diagnosis were correlated with worse final BCVA (Spearman’s rho = 0.688, p=0.005). Conclusion Terson syndrome is a potential cause of irreversible visual loss. Diagnosis delay may affect visual prognosis. PPV is indicated when intraocular haemorrhage is dense and does not resolve spontaneously or when visual acuity at presentation is low, allowing for good visual outcomes with minimal complications.

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“…In one study, it was also suggested that different types of intraocular hemorrhage had different prognostic significance, in that mild retinal hemorrhages were more strongly associated with a better prognosis than large preretinal hemorrhages or vitreous hemorrhages [13] . Most intravitreal hemorrhages resolve spontaneously [14] . Only 40% of cases require vitrectomy, and only half of these also require internal limiting membrane detachment.…”

Section: Discussionmentioning

confidence: 99%

“…The main monitoring parameters are visual acuity and the evolution of the intraocular hemorrhage, but above all, the early detection of the appearance of other elements compromising the visual prognosis. Monitoring is then clinical but also radiological by ocular ultrasound or even other explorations such as OCT. [2] , [14] If the hemorrhage does not resolve or does not progress well, a pars plana vitrectomy is indicated, especially for intravitreal hemorrhage [5] , [14] . However, a surgical approach is not possible in the presence of intraretinal hemorrhage [15] .…”

Section: Discussionmentioning

confidence: 99%

Terson syndrome: Two case reports

Issiaka

Mchachi

Rachid

et al. 2022

International Journal of Surgery Case Reports

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Purpose Vitreous or retinal hemorrhage occurring in association with subarachnoid hemorrhage (SAH) is known as Terson syndrome (TS). Its incidence is of the order of 10–50% after subarachnoid hemorrhage. We report two cases of TS with different clinical presentations, different managements, and a good final prognosis, which were managed at the Ibn Rochd hospital in Casablanca. Observations We report two cases of TS. The first one occurred in a 55-year-old hypertensive man following a ruptured aneurysm of the internal carotid artery, revealed by a decrease in visual acuity concomitant with the neurological symptomatology. The evolution was favorable after specialized neurological management and spontaneous resorption of the intravitreal hemorrhage was obtained 3 months after the acute episode with good visual recovery. The second case was that of a 45-year-old man who presented with an intravitreal hemorrhage of the right eye, 24 h after severe head trauma responsible for a bifrontal extradural hematoma. The B-mode ocular ultrasound discovery of a retinal detachment with persistent hemorrhage led to the indication of a pars plana vitrectomy with retinal tamponade, which allowed visual rehabilitation without recurrence after 1 year. Conclusions Ophthalmologic evaluation by specialized examination and radiology (ocular ultrasound, OCT) is necessary for all patients with TS because early diagnosis and treatment can prevent visual loss and associated complications. Treatment of TS can be conservative and based on periodic monitoring. A pars plana vitrectomy is considered in some cases.

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Terson's syndrome, the current concepts and management strategies: A review of literature

Cited by 23 publications

References 63 publications

Neonatal Aneurysm Rupture in a Child with a De Novo Variant to ANKRD17

Neonatal Aneurysm Rupture in a Child with a De Novo Variant to ANKRD17

Terson Syndrome – Clinical Presentation, Management, and Visual Outcomes in a Tertiary Centre

Terson syndrome: Two case reports

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