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Johnson M. Terson Syndrome Diagnosed by Ocular Point of Care Ultrasound on the Medical Floor. POCUS JOURNAL 2024; 9:36-40. [PMID: 38681167 PMCID: PMC11044924 DOI: 10.24908/pocus.v9i1.16660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
In acute care environments, accurately assessing complications of intracranial pathology can be challenging. Ocular complications in acute intracranial disease are not consistently evaluated despite their high morbidity. We report on a case of monocular diplopia in a 63-year-old man with subacute traumatic brain injury with localized subarachnoid hemorrhage. Ocular point of care ultrasound (POCUS) identified features of vitreous hemorrhage in one globe, leading to a diagnosis of Terson syndrome and a timely referral to ophthalmology. This finding was made on the medical floor days after the initial presentation during rehabilitation when ophthalmoscopy was not possible, and vitreous hemorrhage had not been identified on presentation. Terson syndrome is a seldom discussed but important complication of intracranial hemorrhage generally associated with poor patient outcomes. Ocular POCUS can provide a useful alternative in assessing ocular complications of acute intracranial disease on the medical floor, particularly when the practicalities of performing ophthalmoscopy are challenged.
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Affiliation(s)
- Mark Johnson
- Department of Long-Term Unscheduled Care, Harrogate and District Foundation TrustHarrogate, YorkshireUK
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2
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Stevanovic M, Eliott D. Terson Syndrome: A Review of the Literature. Int Ophthalmol Clin 2024; 64:89-106. [PMID: 38525984 DOI: 10.1097/iio.0000000000000502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/26/2024]
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3
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Göttsche J, Knospe V, Sauvigny T, Schweingruber N, Grensemann J, Spitzer MS, Westphal M, Skevas C, Czorlich P. Terson Syndrome in Patients with Aneurysmal Subarachnoid Hemorrhage: A 10-Year Single-Center Experience. Neurocrit Care 2023; 39:155-161. [PMID: 36949361 PMCID: PMC10499731 DOI: 10.1007/s12028-023-01701-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 02/14/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Terson syndrome (TS), an intraocular hemorrhage associated with aneurysmal subarachnoid hemorrhage (aSAH), occurs in up to 46% of all patients with subarachnoid hemorrhage. Despite its high incidence, TS is underrepresented in the literature, and patients with aSAH are sometimes not systematically evaluated for the presence of TS in clinical practice. This work aims to raise awareness of TS, reevaluate previous scientific findings, describe risk factors associated with the occurrence of TS, and present our local diagnostic and treatment concept. METHODS All patients with aSAH treated at our institution between October 2010 and May 2020 were included in this retrospective study. The frequency of ophthalmological screening by indirect funduscopy, as well as the results, was investigated. In addition, the collection and statistical analysis of epidemiological and clinical data was performed using χ2, Kruskal-Wallis, and analysis of variance testing; multivariate regression; and receiver operating characteristic analysis. The significance level was set at p < 0.05. RESULTS A total of 617 patients were treated for aSAH in our institution. Of these, 367 patients (59.5%) were ophthalmologically examined for the presence of TS. The rate of TS in the examined patients was 21.3% (n = 78). Patients with TS had significantly higher Fisher and World Federation of Neurosurgical Societies (WFNS) scores (p < 0.0001). Regression analyses showed WFNS grade (p = 0.003) and the occurrence of seizures (p = 0.002) as independent predictors of TS, as did receiver operating characteristic analyses, which had a significant area under the curve of 0.66 for the combination of WFNS grade and seizures. For 12 (15.4%) patients, the TS had to be surgically treated by pars plana vitrectomy in a total of 14 eyes, which resulted in significant improvement of visual function in all patients: mean preoperative best-corrected visual acuity was 0.03 (± 0.08) versus 0.76 (± 0.21) postoperatively (p < 0.001). CONCLUSIONS TS is a common complication in patients with aSAH, affecting approximately one in five patients. A higher WFNS grade and the occurrence of seizures are associated with TS; therefore, screening for TS should be performed in these patients.
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Affiliation(s)
- Jennifer Göttsche
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
| | - Volker Knospe
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Sauvigny
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils Schweingruber
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jörn Grensemann
- Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin S Spitzer
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Manfred Westphal
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christos Skevas
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Patrick Czorlich
- Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Foulsham W, North VS, Botsford BW, Dinkin MJ, Henderson F, Godfrey KJ, D'Amico DJ, Schwartz TH, Orlin A. Multilayered macular hemorrhages as an unusual complication of transorbital neuroendoscopic surgery. Am J Ophthalmol Case Rep 2022; 26:101556. [PMID: 35514795 PMCID: PMC9062224 DOI: 10.1016/j.ajoc.2022.101556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 04/12/2022] [Accepted: 04/20/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose To report a case of multilayered intraocular hemorrhage at the posterior pole as a complication of transorbital neuroendoscopic surgery. Observations Our patient underwent an uncomplicated endoscopic transorbital resection of a left sphenoid wing meningioma. In the immediate post-operative period, the patient reported blurred vision of her left eye, and dilated fundus examination demonstrated multilayered hemorrhages at the posterior pole. No intracranial hemorrhage was identified on post-operative imaging. Due to persistent subnormal visual acuity and non-clearing hemorrhage over several weeks of follow-up, a pars plana vitrectomy with peeling of the internal limiting membrane was performed to clear the hemorrhagic component obscuring the macula. Conclusions and Importance We report the first case of multilayered intraocular hemorrhages at the posterior pole, mimicking Terson syndrome, in the absence of intracranial hemorrhage or elevated intracranial pressure as a complication of transorbital surgery.
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Aboulhosn R, Raju B, Jumah F, Majmundar N, Prenner J, Matin T, Roychowdhury S, Singla A, Khandelwal P, Nanda A, Gupta G. Terson's syndrome, the current concepts and management strategies: A review of literature. Clin Neurol Neurosurg 2021; 210:107008. [PMID: 34775364 DOI: 10.1016/j.clineuro.2021.107008] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 10/20/2022]
Abstract
Terson's Syndrome describes intraocular hemorrhage secondary to an acutely raised intracranial pressure (ICP). Although Terson's Syndrome is common amongst patients with subarachnoid hemorrhage (SAH), it is underdiagnosed and often overlooked. This review discusses the current understanding of the etiopathogenesis, clinical features, and management of Terson's Syndrome and highlights the visual and prognostic implications to stress the importance of timely diagnosis and management. The origin of intraocular hemorrhage in Terson's Syndrome has been debated. A recognized theory suggests that an acutely raised ICP induces effusion of cerebrospinal fluid into the optic nerve sheath which dilates the retrobulbar aspect of the sheath in the orbit. Dilatation mechanically compresses the central retinal vein and retinochoroidal veins resulting in venous hypertension and rupture of thin retinal vessels. A commonly reported clinical feature is decreased visual acuity and blurred vision. These may be accompanied by symptoms of increased ICP including loss of consciousness and headache. Diagnosis is established using evidence from the clinical presentation, ophthalmoscopy, and, when required, imaging including B-mode ultrasound, CT, MRI, and fluorescein angiography. Terson's Syndrome is managed conservatively by observation for mild cases and with vitrectomy for bilateral cases and for patients whose hemorrhage has not spontaneously resolved after an observational period. Terson's Syndrome can be used as a prognostic indicator of morbidity and mortality in underlying pathology like SAH. Fundoscopy of patients with SAH, acutely raised ICP or visual disturbance with unknown etiology can help establish a timely Terson's Syndrome diagnosis. This may avoid the risk of permanent visual impairment.
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Affiliation(s)
- Rabii Aboulhosn
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Forester Hill, Aberdeen, UK
| | - Bharath Raju
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Fareed Jumah
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Neil Majmundar
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Jonathan Prenner
- Department of Ophthalmology, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Tariq Matin
- Department of Interventional Radiology, Narayana Superspecialty Hospital, Nathupur, Gurugram, Haryana 122002, India
| | - Sudipta Roychowdhury
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Amit Singla
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Priyank Khandelwal
- Department of Neurosurgery, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Rutgers, Robert Wood Johnson Medical School & University, Hospital, New Brunswick, NJ, USA.
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Kumaria A, Gruener AM, Dow GR, Smith SJ, Macarthur DC, Ingale HA. An explanation for Terson syndrome at last: the glymphatic reflux theory. J Neurol 2021; 269:1264-1271. [PMID: 34170402 DOI: 10.1007/s00415-021-10686-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 10/21/2022]
Abstract
Terson Syndrome (TS) describes the presence of intraocular hemorrhage in patients with intracranial hemorrhage, typically subarachnoid hemorrhage. Despite TS being a well-defined and frequently occurring phenomenon, its pathophysiology remains controversial. This review will present the current understanding of TS, with view to describing a contemporary and more plausible pathomechanism of TS, given recent advances in ophthalmic science and neurobiology. Previously proposed theories include a sudden rise in intracranial pressure (ICP) transmitted to the optic nerve sheath leading to rupture of retinal vessels; or intracranial blood extending to the orbit via the optic nerve sheath. The origin of blood in TS is uncertain, but retinal vessels appear to be an unlikely source. In addition, an anatomical pathway for blood to enter the eye from the intracranial space remains poorly defined. An ocular glymphatic system has recently been described, drainage of which from the globe into intracranial glymphatics is reliant on the pressure gradient between intraocular pressure and intracranial pressure. The glymphatic pathway is the only extravascular anatomical conduit between the subarachnoid space and the retina. We propose that subarachnoid blood in skull base cisterns near the optic nerve is the substrate of blood in TS. Raised ICP causes it to be refluxed through glymphatic channels into the globe, resulting in intraocular hemorrhage. We herewith present glymphatic reflux as an alternative theory to explain the phenomenon of Terson Syndrome.
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Affiliation(s)
- Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.
| | - Anna M Gruener
- School of Medicine, University of Nottingham, Nottingham, UK.,Department of Ophthalmology, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Graham R Dow
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
| | - Stuart J Smith
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Donald C Macarthur
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK.,School of Medicine, University of Nottingham, Nottingham, UK
| | - Harshal A Ingale
- Department of Neurosurgery, Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Derby Road, Nottingham, NG7 2UH, UK
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Ebert JJ, Varma H, Sisk RA. Unilateral Terson-Like Syndrome in a Patient With a Perinatal Ischemic Stroke. Ophthalmic Surg Lasers Imaging Retina 2020; 51:592-595. [PMID: 33104227 DOI: 10.3928/23258160-20201005-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/29/2020] [Indexed: 11/20/2022]
Abstract
Terson syndrome typically presents with bilateral hemorrhagic retinopathy associated with acute intracranial bleeding. The authors present a case of neonatal hemispheric ischemic stroke with vasogenic edema and increased intracranial pressure creating a unilateral Terson-like syndrome. Magnetic resonance imaging indicated congenital occlusion of the left internal carotid artery, among other vascular abnormalities. Chronic submacular, peripheral subretinal, and vitreous hemorrhage were observed, suggesting a multilaminar hemorrhagic process resembling Terson syndrome without frank intracranial hemorrhage. The patient underwent successful lens-sparing vitrectomy of the left eye. A unilateral Terson-like syndrome can result from severe cerebral edema following neonatal stroke in the setting of multiple congenital cerebrovascular abnormalities. [Ophthalmic Surg Lasers Imaging Retina. 2020;51:592-595.].
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Stewart MW, Hasan SA, Collins C, Stanko C, Summer J, Brazis PW, Tawk R, Freeman WD. Can Baseline Computed Tomography Scans Be Used to Identify Patients at High Risk of Vision Loss due to Terson Syndrome? Am J Ophthalmol 2020; 211:217-228. [PMID: 31562856 DOI: 10.1016/j.ajo.2019.09.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 09/14/2019] [Accepted: 09/16/2019] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine if routinely performed computed tomographic (CT) scanning in patients with aneurysmal subarachnoid hemorrhages (aSAHs) is sufficient to identify patients at high risk of vision loss due to Terson syndrome (TS). METHODS Consecutive patients with a diagnosis of aSAH admitted to the neurologic intensive care unit of a regional referral hospital over a 3-year period were prospectively evaluated. Head CT scans performed in the emergency department were assessed for the presence of a "crescent sign" (evidence of significant subinternal limiting membrane hemorrhage). Dilated funduscopic examinations were performed by an ophthalmologist, masked to the results of the CT scan, to identify retinal and vitreous hemorrhages consistent with TS. Retinal hemorrhages were categorized according to size-those smaller than 2 mm in diameter were deemed low risk (lrTS) for vision loss and those larger than 2 mm in diameter were deemed high risk (hrTS) for vision loss. RESULTS One hundred seventeen patients with aSAH were enrolled in the study. The overall incidence of TS was 24.9% (29 of 117 patients; 12 were bilateral). Compared to patients without TS, those with TS had a higher Fisher Hemorrhage Grade and a lower mean (±standard deviation) GCS score (8.66 ± 4.97 vs 12.09 ± 1.10; P < 0.001). The CT crescent sign was positive in 7 patients (6.0%), 6 (5.1%; 2 were bilateral) of whom were found to have hrTS. Of the 110 patients without a CT crescent sign, 88 (75.1%) patients did not have TS, 21 had lrTS, and 1 patient had hrTS in one eye. The CT crescent sign was highly sensitive (85.7%) and specific (99.1%) for diagnosing hrTS. CONCLUSION The CT crescent sign is a highly sensitive and specific marker for hrTS. CT scanning may replace routine ophthalmologic examinations to identify patients at risk of vision loss due to aSAH.
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Affiliation(s)
- Michael W Stewart
- Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, Florida, USA.
| | - Syed A Hasan
- Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Christina Collins
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Carlene Stanko
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Jennifer Summer
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Paul W Brazis
- Department of Ophthalmology, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - Rabih Tawk
- Department of Neurosurgery, Mayo Clinic Florida, Jacksonville, Florida, USA
| | - W David Freeman
- Department of Neurology, Mayo Clinic Florida, Jacksonville, Florida, USA
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9
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Hong EH, Seong M, Yeom H, Choi S, Choi KS, Kang MH, Cho H, Shin YU. Incidence of Terson Syndrome in Treated Subarachnoid Hemorrhage in South Korea: a National Health Insurance Database Study. Sci Rep 2019; 9:19048. [PMID: 31836842 PMCID: PMC6911003 DOI: 10.1038/s41598-019-55566-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 11/29/2019] [Indexed: 12/31/2022] Open
Abstract
The aim of this study is to investigate the incidence and mortality of Terson syndrome in patients with treated subarachnoid hemorrhage (SAH) in South Korea. In this nationwide, population-based study, we used the National Health Insurance(NHI) database (2011–2015) to identify patients aged ≥18 years. Newly diagnosed non-traumatic SAH, treated using clipping or coil embolization, were identified, and Terson syndrome was defined as newly diagnosed retinal or vitreous hemorrhage within 3 months of SAH diagnosis. We identified 22,864 patients with treated SAH (tSAH), 196 of whom had Terson syndrome, with the cumulative incidence during 5 years of 0.86% (95% CI: 0.74–0.98): 1.10% (95% CI: 0.88–1.33) in men and 0.71% (95% CI, 0.58–0.85) in women. The cumulative incidence of Terson syndrome in patients aged under 40 was higher than in those aged 40 or over (1.41% vs. 0.81%; p = 0.007). The mortality rate of Terson syndrome in patients with tSAH was not different from that in those without Terson syndrome (4.08% vs. 7.30%; p = 0.089). This was the first nationwide epidemiological study of Terson syndrome using a population-based database. The incidence of Terson syndrome in patients with tSAH was higher in those age under 40 than in those aged 40 or over.
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Affiliation(s)
- Eun Hee Hong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Mincheol Seong
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Hosuck Yeom
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Sungyong Choi
- Big Data Division, Seoul Metropolitan Government, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University College of Medicine, Seoul, Korea
| | - Min Ho Kang
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea
| | - Heeyoon Cho
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea.
| | - Yong Un Shin
- Department of Ophthalmology, Hanyang University College of Medicine, Seoul, Korea.
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10
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Liu X, Yang L, Cai W, Gao L, Li Y. Clinical features and visual prognostic indicators after vitrectomy for Terson syndrome. Eye (Lond) 2019; 34:650-656. [PMID: 31455901 DOI: 10.1038/s41433-019-0547-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Revised: 04/29/2019] [Accepted: 05/28/2019] [Indexed: 11/10/2022] Open
Abstract
PURPOSE To determine clinical characteristics and identify factors associated with better visual outcomes in patients who had vitrectomy for vitreous haemorrhage (VH) associated with Terson syndrome (TS). METHODS The records of 48 patients (54 corresponding eyes) who underwent vitrectomy for VH associated with TS from January 2008 to December 2017 were retrospectively reviewed. The main outcome measure was the final postoperative visual acuity. RESULTS At the last visit, 34 eyes (63.0%) achieved a BCVA of 0.3 or better. Eyes associated with traumatic brain injury had a better visual outcome than those with primary intracerebral haemorrhage (P = 0.042). In the primary intracerebral haemorrhage group, patients with hypertension-induced intracranial haemorrhage (IH) showed poorer final visual acuities than the ruptured intracranial aneurysm group (P = 0.023). In the delayed vitrectomy group, epiretinal membrane and peripheral retina changes were more common (P < 0.05). However, the difference in final visual acuity between the early and delayed vitrectomy groups was not significant (P = 0.69). CONCLUSION Most of the patients obtained visual recovery after vitrectomy for TS. VH associated with ruptured intracranial aneurysm or traumatic brain injury or eyes without retinal haemorrhage are predictive of better prognosis. Although the timing of vitrectomy was not related to the final postoperative visual outcome, early vitrectomy by three months seems to suggest less epiretinal membrane formation, retinal tears, and retinal detachments.
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Affiliation(s)
- Xin Liu
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Longfei Yang
- Jilin Provincial Key Laboratory on Molecular and Chemical Genetics, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Wenrui Cai
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Linlin Gao
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China
| | - Yaping Li
- Eye Center, The Second Hospital of Jilin University, #218 Ziqiang Street, Changchun, 130000, Jilin, China.
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Abstract
PURPOSE To characterize the presentation of Terson syndrome, the occurrence of a vitreous hemorrhage in association with intracranial hemorrhage, and report on the outcomes of vitrectomy at two major centers in Canada. METHODS Retrospective chart review of consecutive patients with Terson syndrome undergoing vitrectomy by retina specialists over the last 10 years. Primary outcome was the change in best-corrected visual acuity (BCVA) at 3 months from baseline. Secondary outcomes included the association between baseline BCVA and final BCVA, and the association between final BCVA and timing of surgery (early vs. later than 90 days). RESULTS A total of 14 eyes of 11 patients were included. The mean time between observation of intraocular hemorrhage and vitrectomy was 160 days. Baseline preoperative BCVA was logarithm of the minimum angle of resolution 1.57 ± 1.03 (Snellen 20/740), which improved to logarithm of the minimum angle of resolution 0.53 ± 0.82 (Snellen 20/70) at the final postoperative follow-up, P = 0.01. Baseline BCVA was not significantly correlated with final BCVA, Spearman's rho = 0.016, P = 0.957. Final BCVA did not significantly differ between those who had surgery before 90 days compared with after 90 days, P = 0.087. CONCLUSION Vitrectomy is safe and effective and should be considered for nonclearing vitreal bleeding due to Terson syndrome. Ocular hemorrhaging in Terson syndrome can be observed conservatively for spontaneous improvement without the risk of reduced visual potential. Ophthalmic evaluation should be considered promptly after intracranial hemorrhage.
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Ren Y, Wu Y, Guo G. Terson syndrome secondary to subarachnoid hemorrhage: a case report and literature review. World Neurosurg 2018; 124:S1878-8750(18)32907-3. [PMID: 30599249 DOI: 10.1016/j.wneu.2018.12.084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 12/07/2018] [Accepted: 12/10/2018] [Indexed: 12/24/2022]
Abstract
BACKGROUND Terson syndrome is a serious complication of subarachnoid hemorrhage includes any intraocular hemorrhage and may result in blurred vision or even blindness. However, it is often overlooked clinically. CASE DESCRIPTION A 42-year-old man presented with coma due to rupture of a left posterior communicating artery aneurysm. A preoperative CT scan demonstrated subarachnoid hemorrhage (SAH) and bilateral fundus hemorrhage. Visual evoked potential (VEP) and B-scan ocular ultrasound revealed vitreous hemorrhages, features consistent with Terson syndrome. Pars plana vitrectomy was performed 2 weeks after SAH with a subsequent improvement of visual acuity. CONCLUSIONS Early identification is important for the recovery of the patient's nervous system and ophthalmology. Neurosurgeons should be aware of the pathology and pay attention to it to maximize patient's benefit.
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Affiliation(s)
- Yeqing Ren
- The Second Clinical Medical College of Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Yongqiang Wu
- Department of Neurosurgery, the First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, China
| | - Geng Guo
- Department of Neurosurgery, the First Hospital, Shanxi Medical University, Taiyuan, Shanxi 030001, China.
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14
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Moteki Y, Niimi Y, Okada Y, Kawamata T. Ruptured Vertebral Artery Dissecting Aneurysm as a Risk Factor for Ocular Symptoms Accompanied with Subarachnoid Hemorrhage. World Neurosurg 2018; 116:e505-e512. [DOI: 10.1016/j.wneu.2018.05.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 05/02/2018] [Accepted: 05/03/2018] [Indexed: 12/23/2022]
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15
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Abstract
Terson's Syndrome is represented by a vitreous, retrohyaloid, retinal, or subretinal hemorrhage occurring consequent to an acute intracranial hemorrhage or elevated intracranial pressure. The outcome may include a complete clearing of the blood and the restoration of VA or persistent hemorrhage. This report presents the case of a 43-year-old woman who underwent bilateral surgery for a persistent vitreous hemorrhage and a hematoma underneath the internal limiting membrane in the left eye. The event followed shortly after a subarachnoid hemorrhage due to the rupture of a posterior communicating artery aneurism. Vitrectomy was performed in both eyes, together with the peeling of the internal limiting membrane in the left eye, followed by a bilateral good outcome.
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Affiliation(s)
- Andreea Moraru
- "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania.,"Prof. N. Oblu" Hospital, Iaşi, Romania
| | - Ruxandra Mihailovici
- "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania.,"Prof. N. Oblu" Hospital, Iaşi, Romania
| | - Dănuţ Costin
- "Grigore T. Popa" University of Medicine and Pharmacy, Iaşi, Romania.,"Prof. N. Oblu" Hospital, Iaşi, Romania
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Leonardo Gordinho A, Rosado S, Mesquita T, Ferreira NR. Blind spot: blindness as initial presentation of subarachnoid haemorrhage. BMJ Case Rep 2018; 2018:bcr-2017-222745. [PMID: 29636335 DOI: 10.1136/bcr-2017-222745] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 47-year-old Caucasian man with arterial hypertension was admitted after a seizure. At the emergency department, he presented with high blood pressure, bilateral vision loss (evidenced by unresponsiveness to threatening stimuli), right hemiplegia and severe agitation. The brain CT angiography showed a diffuse basal cisterns subarachnoid haemorrhage with a ruptured basilar aneurysm. He was admitted for neurovascular procedure and embolisation. The patient's neurological examination improved but blindness persisted. A funduscopic examination revealed a left eye vitreous haemorrhage and diffuse retinal haemorrhages in the posterior pole. Assuming the haemorrhages were the cause of blindness, Terson syndrome was diagnosed. The patient underwent vitrectomy surgery being discharged 5 days later maintaining left eye blindness and able to count fingers from 1 m distance with the right eye. Two months after discharge, he was re-evaluated at our clinic with left eye blurred vision and almost normal right eye visual acuity.
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Affiliation(s)
| | - Steeve Rosado
- Department of Medicine, Hospital Beatriz Angelo, Loures, Portugal
| | - Teresa Mesquita
- Department of Medicine, Hospital Beatriz Angelo, Loures, Portugal
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Mao X, You Z. 25G compared with 20G vitrectomy under Resight non-contact wide-angle lenses for Terson syndrome. Exp Ther Med 2017; 14:1193-1197. [PMID: 28810578 DOI: 10.3892/etm.2017.4592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 11/04/2016] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to compare the effectiveness of 25G vitrectomy to standard 20G vitrectomy for treatment of Terson syndrome under Resight non-contact wide-angle lenses. This was a case-control study of 20 patients with Terson syndrome (study group) that underwent 25G vitrectomy under Resight non-contact wide-angle lenses, with those of 20 matched patients that underwent 20G vitrectomy (control group). Medical records were reviewed from between July 2011 and October 2013. Data included results of the Early Treatment Diabetic Retinopathy Study examination, ophthalmology B-scan ultrasonography and fundus photography. The mean age, follow-up time, the preoperative visual acuity of LogMAR and the preoperative intraocular pressure (IOP) were all comparable in the two groups (all P>0.05). There were statistically significant differences in postoperative visual acuity of LogMAR compared with preoperative visual acuity (P<0.001) in both groups, but no difference between the groups (P=0.845). However, the operative times (13.5 min in study group vs. 42 min in control group) and post-operative IOP at day 1 (13.5 vs. 20 mmHg) were significantly reduced in the study group compared to the control group (P<0.001). Therefore, the present findings suggest that 25G Vitrectomy for Terson syndrome under Resight non-contact wide-angle lenses can achieve a significantly shorter operative time and lower post-operative IOP compared with 20G Vitrectomy.
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Affiliation(s)
- Xinbang Mao
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
| | - Zhipeng You
- Department of Ophthalmology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, P.R. China
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Narayanan R, Taylor SC, Nayaka A, Deshpande R, St Aubin D, Hrisomalos FN, Hu J, Rajagopal R, Tewari A, Apte RS. Visual Outcomes after Vitrectomy for Terson Syndrome Secondary to Traumatic Brain Injury. Ophthalmology 2016; 124:118-122. [PMID: 27817917 DOI: 10.1016/j.ophtha.2016.09.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/31/2016] [Accepted: 09/12/2016] [Indexed: 01/04/2023] Open
Abstract
PURPOSE To evaluate visual outcomes after vitrectomy for intraocular hemorrhages secondary to traumatic brain injury. DESIGN Retrospective, observational case series. PARTICIPANTS A total of 28 eyes in 20 patients undergoing vitrectomy for Terson syndrome secondary to traumatic brain injury between 1997 and 2015. METHODS We reviewed the records of patients undergoing a standard 20-gauge or 23-gauge pars plana vitrectomy for intraocular hemorrhages secondary to traumatic brain injury, and the timing of vitrectomy in relation to the inciting intracranial event was recorded. MAIN OUTCOME MEASURES The primary outcome measure was the change in the preoperative visual acuity score at postoperative month 1 and at the last noted clinic appointment. RESULTS A total of 28 eyes in 20 patients (all male) underwent pars plana vitrectomy for intraocular hemorrhages secondary to traumatic brain injury. The mean preoperative baseline logarithm of the minimum angle of resolution (logMAR) (Snellen) best-corrected visual acuity (BCVA) was 1.81±0.56 (20/1290). At 1-month postoperative follow-up, the mean BCVA was 0.30±0.33 (20/40). At the date of the last follow-up, the mean BCVA was 0.15±0.24 (20/30) and the median BCVA was 0.00 (20/20). Although the difference between preoperative and postoperative BVCA was significantly different at 1 month and the final postoperative clinic visits (P < 0.001), there was not a correlation between preoperative visual acuity as a predictor of final postoperative visual acuity outcome (r=-0.32; P = 0.09; 95% confidence interval [CI] -0.62 - 0.06). At the date of the last follow-up, the differences in visual outcomes between the individuals undergoing vitrectomy within 3 months of the inciting event, 0.08±0.15 (20/25), were not significantly different than those undergoing surgical intervention after 3 months, 0.18±0.27 (20/30) (P = 0.28). Three cases among those undergoing vitrectomy after 3 months were complicated by retinal detachment, none of which resulted in a BCVA worse than when the patient originally presented preoperatively. CONCLUSIONS In this retrospective series of patients without other ocular pathology, surgical intervention effectively provided rapid visual recovery in the majority of individuals with intraocular hemorrhages secondary to traumatic brain injury, irrespective of the timing of vitrectomy or of preoperative visual acuity.
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Affiliation(s)
| | - Stanford C Taylor
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | | | | | - Daniel St Aubin
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Frank N Hrisomalos
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Jonathan Hu
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Rithwick Rajagopal
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri
| | - Asheesh Tewari
- Kresge Eye Institute, Department of Ophthalmology, Wayne State University School of Medicine, Detroit, Michigan
| | - Rajendra S Apte
- Department of Ophthalmology and Visual Sciences, Washington University in St. Louis, St. Louis, Missouri.
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19
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Nunes DM, Dutra BG, Maia ACM, Boni RC, Rocha AJD. Terson's syndrome following an aneurysmal subarachnoid hemorrhage: an imaging prognostic finding you should recognize. ARQUIVOS DE NEURO-PSIQUIATRIA 2016; 74:513. [PMID: 27338646 DOI: 10.1590/0004-282x20160057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Accepted: 03/28/2016] [Indexed: 06/06/2023]
Affiliation(s)
- Douglas Mendes Nunes
- Santa Casa de Misericórdia de São Paulo, Setor de Neurorradiologia, São Paulo SP, Brasil
| | - Bruna Garbugio Dutra
- Santa Casa de Misericórdia de São Paulo, Setor de Neurorradiologia, São Paulo SP, Brasil
| | | | - Reginaldo Carlos Boni
- Santa Casa de Misericórdia de São Paulo, Serviço de Procura de Órgãos e Tecidos, São Paulo SP, Brasil
| | - Antônio José da Rocha
- Santa Casa de Misericórdia de São Paulo, Setor de Neurorradiologia, São Paulo SP, Brasil
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20
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Terson syndrome in aneurysmal subarachnoid hemorrhage-its relation to intracranial pressure, admission factors, and clinical outcome. Acta Neurochir (Wien) 2016; 158:1027-36. [PMID: 27038169 DOI: 10.1007/s00701-016-2766-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 02/29/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND A large number of reports have not been able to clarify the pathophysiology of Terson syndrome (TS) in aneurysmal subarachnoid hemorrhage (aSAH). METHODS Prospective single-center study on aSAH patients. Fundoscopic and radiological signs of TS were assessed. The opening intracranial pressure (ICP) in patients who required a ventriculostomy was recorded with a manometer. RESULTS Six out of 36 included patients had TS (16.7 %), which was associated with unfavorable admission scores. Twenty-nine patients (80.5 %) required ventriculostomy; TS was associated with higher ICP (median, 40 vs. 15 cm cmH2O, p = .003); all patients with TS had pathological ICP values of >20 cmH2O. Patients with a ruptured aneurysm of the anterior cerebral artery complex were ten times as likely to suffer from TS (OR 10.0, 95 % CI 1.03-97.50). Detection of TS on CT had a sensitivity of 50 %, a specificity of 98.4 %, a positive predictive value of 83.3 %, and a negative predictive value of 92.4 %. Mortality was 45 times as high in patients with TS (OR 45.0, 95 % CI 3.86-524.7) and neurologic morbidity up until 3 months post-aSAH was significantly higher in patients with TS (mRS 4-6; 100 vs. 17 %; p = .001). CONCLUSIONS Our findings demonstrate an association between raised ICP and the incidence of TS. TS should be ruled out in aSAH patients presenting comatose or with raised ICP to ensure upfront ophthalmological follow-up. In alert patients without visual complaints and a TS-negative CT scan, the likelihood for the presence of TS is very low.
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21
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Lee GI, Choi KS, Han MH, Byoun HS, Yi HJ, Lee BR. Practical Incidence and Risk Factors of Terson's Syndrome: A Retrospective Analysis in 322 Consecutive Patients with Aneurysmal Subarachnoid Hemorrhage. J Cerebrovasc Endovasc Neurosurg 2015; 17:203-8. [PMID: 26526120 PMCID: PMC4626343 DOI: 10.7461/jcen.2015.17.3.203] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 06/18/2015] [Accepted: 07/08/2015] [Indexed: 11/25/2022] Open
Abstract
Objective Terson's syndrome, a complication of visual function, has occasionally been reported in patients with aneurysmal subarachnoid hemorrhage (SAH), however the factors responsible for Terson's syndrome in aneurysmal SAH patients have not yet been fully clarified. In this study, we report on potential risk factors for prediction and diagnosis of Terson's syndrome in the earlier stage of the disease course in patients with aneurysmal SAH. Materials and Methods The authors retrospectively analyzed the data of 322 consecutive patients who suffered from aneurysmal SAH in a single institution between Jan. 2007 and Dec. 2013. Medical records including demographics, neurologic examination, and radiologic images were collected to clarify the risk factors of Terson's syndrome. Patients with visual problem were consulted to the Department of Ophthalmology. Results Among 332 patients with aneurysmal SAH, 34 patients were diagnosed as Terson's syndrome. Four individual factors, including World Federation of Neurosurgical Societies (WFNS) grade at admission, aneurysm size, method of operation, and Glasgow outcome scale showed statistically significant association with occurrence of Terson's syndrome. Of these, WFNS grade at admission, aneurysm size, and method of operation showed strong association with Terson's syndrome in multivariate analysis. Terson's syndrome accompanied by papilledema due to increased intracranial pressure led to permanent visual complication. Conclusion In patients with aneurysmal SAH, the patients' WFNS grade at admission, the size of the aneurysms, particularly the diameter of the aneurysm dome, and the method of operation might influence development of Terson's syndrome.
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Affiliation(s)
- Gun-Ill Lee
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Kyu-Sun Choi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Myung-Hoon Han
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyoung-Soo Byoun
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Hyeong-Joong Yi
- Department of Neurosurgery, Hanyang University Medical Center, Seoul, Korea
| | - Byung-Ro Lee
- Department of Ophthalmology, Hanyang University Medical Center, Seoul, Korea
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22
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Bäuerle J, Gross NJ, Egger K, Neubauer J, Niesen WD, Buttler KJ, Lagrèze WA, Reinhard M. Terson's Syndrome: Diagnostic Comparison of Ocular Sonography and CT. J Neuroimaging 2015; 26:247-52. [DOI: 10.1111/jon.12285] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 06/18/2015] [Accepted: 07/03/2015] [Indexed: 11/28/2022] Open
Affiliation(s)
- Jochen Bäuerle
- Department of Neurology; University Medical Center Freiburg; Freiburg Germany
| | - Nikolai J. Gross
- Department of Ophthalmology; University Medical Center Freiburg; Freiburg Germany
| | - Karl Egger
- Department of Neuroradiology; University Medical Center Freiburg; Freiburg Germany
| | - Jakob Neubauer
- Department of Neuroradiology; University Medical Center Freiburg; Freiburg Germany
| | - Wolf-Dirk Niesen
- Department of Neurology; University Medical Center Freiburg; Freiburg Germany
| | - Klaus-Jürgen Buttler
- Department of Neurology; University Medical Center Freiburg; Freiburg Germany
- Department of Neurosurgery; University Medical Center Freiburg; Freiburg Germany
| | - Wolf A. Lagrèze
- Department of Ophthalmology; University Medical Center Freiburg; Freiburg Germany
| | - Matthias Reinhard
- Department of Neurology; University Medical Center Freiburg; Freiburg Germany
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23
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Monteagudo M, Doménech C, Segura T. Terson syndrome and ocular ultrasound. NEUROLOGÍA (ENGLISH EDITION) 2015. [DOI: 10.1016/j.nrleng.2014.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Abstract
AbstractObjectiveEvaluate the incidence, neurologic morbidity, and mortality of patients with Terson syndrome.MethodsConsecutive patients admitted to the Hamilton General Hospital from May 2012 to May 2013 with a diagnosis of spontaneous subarachnoid hemorrhage (SAH) were recruited. Funduscopic examinations were performed under pharmacological mydriasis. Outcome measures included: (1) the presence or absence of Terson syndrome; (2) The Glasgow Coma Scale (GCS), Hunt and Hess scale (H&H), and SAH Fisher score upon admission to the hospital; (3) the modified Rankin score upon discharge; and (4) and all-cause mortality.ResultsForty-six patients were included and 10 had Terson syndrome (21%). The median H&H, GCS, and Fisher scores were 4, 6.5, and 4.0 for patients with Terson syndrome vs. 2, 14, and 3 for patients without Terson syndrome (p=0.0032, 0.0052, and 0.031), respectively. The median Rankin score was 6 for patients with Terson syndrome vs. 3.5 for patients without Terson syndrome (p=0.0019). The odds of all-cause mortality with Terson syndrome vs. no Terson syndrome was 12: 1 (95% confidence interval 2.33-61.7), p =0.003. Only four of the 10 patients with Terson syndrome survived.ConclusionsBased on this study, approximately one-fifth of patients admitted to the hospital with a spontaneous SAH could have Terson syndrome. Patients with Terson syndrome have significantly worse GCS and H&H scores upon admission to the hospital, lower modified Rankin scores upon discharge, and greater mortality. Thus, Terson syndrome is not rare among patients with SAH and carries a worse prognosis.
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25
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Terson syndrome in subarachnoid hemorrhage, intracerebral hemorrhage, and traumatic brain injury. Neurosurg Rev 2014; 38:129-36; discussion 136. [PMID: 25173620 DOI: 10.1007/s10143-014-0564-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 05/19/2014] [Accepted: 05/24/2014] [Indexed: 12/20/2022]
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.
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26
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Obuchowska I, Turek G, Mariak Z, Mariak Z. Early Intraocular Complications of Subarachnoid Haemorrhage after Aneurysm Rupture. Neuroophthalmology 2014; 38:199-204. [PMID: 27928299 DOI: 10.3109/01658107.2014.911918] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 03/26/2014] [Accepted: 03/28/2014] [Indexed: 11/13/2022] Open
Abstract
The aim of this study was to identify factors predisposing for early intraocular complications of aneurysmal subarachnoid haemorrhage (SAH). The authors analysed 96 selected cases of aneurysmal SAH. Forty patients (42%) demonstrated abnormal fundus findings, including disc swelling (13.5%), retinal haemorrhages (23%), and vitreous haemorrhage (5%). The incidence of intraocular pathologies was significantly higher in patients who lost consciousness at the onset of SAH, were admitted with high scores of the Hunt-Hess and Fisher scales and low score of the Glasgow Coma Scale, as well as in those with arterial hypertension, more sizable aneurysm, and older.
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Affiliation(s)
| | - Grzegorz Turek
- Department of Neurosurgery, Medical University of Bialystok Bialystok Poland
| | - Zenon Mariak
- Department of Neurosurgery, Medical University of Bialystok Bialystok Poland
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27
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Koskela E, Pekkola J, Kivisaari R, Kivelä T, Hernesniemi J, Setälä K, Laakso A. Comparison of CT and clinical findings of Terson's syndrome in 121 patients: a 1-year prospective study. J Neurosurg 2014; 120:1172-8. [DOI: 10.3171/2014.2.jns131248] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Terson's syndrome (TS) is a vitreous hemorrhage in association with subarachnoid hemorrhage (SAH). Its diagnosis is often delayed, which may result in vision loss secondary to treatable conditions. Methods to hasten early diagnosis and consequent ophthalmic referral are desirable. The aims of this study were 1) to assess the specificity and sensitivity of conventional head CT for diagnosing TS in patients with aneurysmal SAH (aSAH); and 2) to determine the incidence of TS and its association with age, sex, aSAH severity, and overall mortality.
Methods
Patients admitted to Helsinki University Central Hospital who underwent surgery or endovascular treatment for a ruptured intracranial aneurysm during 2011 were participants in this prospective study. They underwent serial dilated fundoscopic examinations during a 6-month period. Two radiologists independently reviewed ocular findings suggestive of TS on conventional CT head scans obtained in all patients as a routine diagnostic procedure. Associations between TS and relevant clinical, radiological, and demographic data were analyzed with uni- and multivariate logistic regression.
Results
Of 121 participants, 13 (11%) presented with TS, and another 22 (18%) with intraretinal hemorrhages. For reviewing CT head scans, the overall observed agreement between the 2 raters was 96% (116 of 121 cases), with a substantial κ of 0.69 (95% CI 0.56–0.82). The sensitivity of the CT findings for TS was 42%, and the specificity was 97%. Associations of the World Federation of Neurosurgical Societies (WFNS) and Hunt and Hess grades on admission, the presence of intracerebral hemorrhage, female sex, and aneurysm length with TS were all statistically significant. Logistic regression demonstrated that sex and WFNS grade were independently associated with TS and provided the best fit to the data.
Conclusions
Routinely looking for TS findings in CT head scans may prove valuable in clinical practice. Terson's syndrome is associated with female sex and poor clinical condition on admission.
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Affiliation(s)
| | - Johanna Pekkola
- 2Department of Radiology, HUS Medical Imaging Center, Helsinki University Central Hospital and University of Helsinki, Finland
| | - Riku Kivisaari
- 3Neurosurgery, Helsinki University Central Hospital; and
| | | | | | | | - Aki Laakso
- 3Neurosurgery, Helsinki University Central Hospital; and
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Byun HY, Jung H, Choi HJ, Lee JH, Oh MK, Yoon CH, Shin H, Lee ES. Terson Syndrome after Subarachnoid Hemorrhage Occurred by Thrombolysis and Mechanical Thrombectomy to Treat Acute Ischemic Stroke: A Case Report. BRAIN & NEUROREHABILITATION 2014. [DOI: 10.12786/bn.2014.7.2.136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Affiliation(s)
- Ha Young Byun
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
| | - Hoyeon Jung
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
| | - Hye Jung Choi
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
| | - Joong Hoon Lee
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
| | - Min-Kyun Oh
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
| | - Chul Ho Yoon
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
| | - Heesuk Shin
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
| | - Eun Shin Lee
- Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea
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Rheinboldt M, Francis K, Parrish D, Harper D, Blase J. Terson syndrome in conjunction with ruptured intracranial aneurysm and penetrating intracranial injury: a review of two cases. Emerg Radiol 2013; 21:215-8. [PMID: 24174125 DOI: 10.1007/s10140-013-1172-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2013] [Accepted: 10/17/2013] [Indexed: 11/30/2022]
Abstract
Terson syndrome, the presence of intraocular hemorrhage in the setting of acutely elevated intracranial pressure, was historically described in conjunction with acute subarachnoid hemorrhage; however, more recently, it has been associated with a gamut of intracranial pathophysiology ranging from blunt or penetrating injury to neurosurgical procedures. We describe two cases of profound intracranial injury, secondary to ballistic injury, and a ruptured intracranial aneurysm, in which posterior chamber ocular hemorrhage was noted on CT imaging. Though the outcome in such cases, as with ours, is often poor, the findings are germane to clinical care as the presence of Terson syndrome has been noted to be a negative prognostic factor in multiple clinical reviews. Additionally, clinical recovery can be impacted adversely by lasting visual deficits or retinal degradation in the absence of timely ophthalmologic intervention.
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Affiliation(s)
- Matt Rheinboldt
- Department of Emergency Radiology, Henry Ford Hospital, Detroit, MI, USA,
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30
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Kapoor S. Terson syndrome: an often overlooked complication of subarachnoid hemorrhage. World Neurosurg 2013; 81:e4. [PMID: 23954462 DOI: 10.1016/j.wneu.2013.08.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Revised: 04/08/2013] [Accepted: 08/10/2013] [Indexed: 10/26/2022]
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31
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Monteagudo M, Doménech C, Segura T. Terson syndrome and ocular ultrasound. Neurologia 2013; 30:133-4. [PMID: 23453591 DOI: 10.1016/j.nrl.2012.10.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2012] [Accepted: 10/22/2012] [Indexed: 11/15/2022] Open
Affiliation(s)
- M Monteagudo
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España.
| | - C Doménech
- Servicio de Neurología, Hospital General Universitario de Elche, Alicante, España
| | - T Segura
- Servicio de Neurología, Complejo Hospitalario Universitario de Albacete, Albacete, España
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