Terson syndrome in subarachnoid hemorrhage, intracerebral hemorrhage, and traumatic brain injury

Abstract

This prospective trial was designed to evaluate the incidence of Terson syndrome in patients suffering from subarachnoid hemorrhage, intracerebral hemorrhage, or traumatic brain injury and whether consequences necessarily derive from the intraocular hemorrhage itself. Two ophthalmologic examinations were performed to identify patients with Terson syndrome. Data on initial Glasgow Coma Scale, Hunt and Hess and Fisher grades, aneurysm site and diameter, and volume of hemorrhage in intracerebral hemorrhage patients were correlated to the location and course of Terson syndrome. Follow-up was performed after 3 months, including clinical and ophthalmologic investigations. The data showed that 16 of 83 subarachnoid hemorrhage patients (19.3%), 2 of 22 intracerebral hemorrhage patients (9.1%), and 1 of 32 traumatic brain injury patients (3.1%) suffered from Terson syndrome. Low Glasgow Coma Scale (p = 0.002), high Hunt and Hess grade (p < 0.001), and high Fisher grade (p = 0.002) were found to be associated with a higher incidence of Terson syndrome. The neurological outcome in subarachnoid hemorrhage patients suffering from Terson syndrome was worse compared with that of subarachnoid hemorrhage patients without Terson syndrome (p = 0.005), and vitrectomy was performed in seven eyes of six patients due to poor visual acuity. Terson syndrome is underestimated in patients with subarachnoid hemorrhage and a rare pathology in intracerebral hemorrhage as well as in traumatic brain injury patients. Spontaneous regression of the intraocular hemorrhage may be seen, but in half of the patients, vitrectomy is necessary to prevent permanent visual deterioration.

Carotid cavernous fistula with central retinal artery occlusion and Terson syndrome after mid-facial trauma

“…Terson syndrome is the combination of intraocular (vitreous, sub-hyloid or intraretinal/sub-internal limiting membrane) hemorrhage associated with subarachnoid hemorrhage, intracerebral hemorrhage, or traumatic brain injury [7]. Terson syndrome occurs in 3.1% of traumatic head injuries [7].…”

“…Terson syndrome occurs in 3.1% of traumatic head injuries [7]. Terson syndrome has been reported to be caused by or associated with multiple conditions related to a spike in intracranial pressure.…”

Subarachnoid Hemorrhage in Clinical Practice

“…Many patients who return home have remaining deficits, often cognitive ones. Of those former patients who have returned home, only a third resume previous employment completely [ 27 ], and no more than 5 % feel to have recovered completely [ 28 ].…”

“…However, the data we have strongly support a screening strategy in case of familial subarachnoid hemorrhage. In persons with two or more affected relatives, the lifetime risk of subarachnoid hemorrhage is considerable, with point estimates as high as 25 % [ 27 ]. At initial screening, the chance of finding an aneurysm is around 10 % [ 28 ].…”

Terson’s syndrome following an aneurysmal subarachnoid hemorrhage: an imaging prognostic finding you should recognize

“…TS has also been reported in nonaneurysmal SAH, severe traumatic injuries or venous thrombosis 2 . Current literature has highlighted TS as an important life-threatening prognostic finding 3,4 . Recognizing TS on fundoscopy or CT is recommended and effective control of IP is imperative to reduce the risk of mortality in this critical setting Figure.…”