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Gallo B, Khader R, Fajardo-Sanchez J, Sullivan P, Anikina E. Factors affecting anatomical and visual outcomes in Terson syndrome managed by surgery or observation. Eye (Lond) 2024:10.1038/s41433-024-03113-1. [PMID: 38740960 DOI: 10.1038/s41433-024-03113-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 04/08/2024] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
OBJECTIVES To investigate visual outcomes and prognostic factors of patients with Terson syndrome (TS) managed with observation or pars plana vitrectomy (PPV). METHODS retrospective review of medical records of 117 eyes from 81 patients (43 females) with TS. Main outcome measures were final best corrected visual acuity (BCVA), intraoperative findings and long-term sequelae. RESULTS 46 (39.3%) eyes were managed conservatively and 71 (60.7%) eyes underwent PPV. Median follow-up was 8.4 months. The PPV group had significantly worse (p < 0.001) baseline BCVA (median 2.3 versus 0.7 logMAR, Snellen equivalent 20/4000 versus 20/100). Final BCVA did not differ between the two groups (p = 0.38). Final BCVA ≥ 0.3 logMAR (20/40) in the surgery group was associated with post-operative retinal detachment (p = 0.013) and macular abnormalities (p = 0.014), and in the observation group with ocular comorbidity (p = 0.008). Retinal breaks were detected intraoperatively in 25 (35.2%) eyes and were associated with an interval longer than 3 months between ocular diagnosis and surgery (p = 0.04), but not with larger gauge instrumentation and posterior vitreous detachment. Incidence of ERM did not differ among patients managed conservatively and after PPV (p = 0.9) and between eyes undergoing early or delayed surgery (p = 0.09). The most common post-operative complications were cataract in 16 (22.5%) eyes and ERM in 8 (11.3%) eyes. CONCLUSIONS visual outcomes in TS are similar with both management strategies. Surgery allows faster and greater visual recovery but carries high risk of intraoperative retinal tears if delayed for longer than 3 months from initial presentation. ERM and retinal detachment are not correlated with timing of surgery or management strategy.
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Affiliation(s)
- Beatrice Gallo
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK.
| | - Ramy Khader
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
| | | | - Paul Sullivan
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
| | - Evgenia Anikina
- Royal Berkshire Hospitals NHS Foundation Trust, London Road, Reading, RG1 5AN, UK
- Moorfields Eye Hospital NHS Foundation Trust, City Road, London, EC1V 2PD, UK
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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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Szeligowski T, Fu DJ, Fernandez-Ledo N, Birtel J, Aslam SA, Patel CK, Xue K, Charbel Issa P. PHOTORECEPTOR DAMAGE IN TERSON SYNDROME. Retina 2023; 43:1557-1562. [PMID: 37253246 DOI: 10.1097/iae.0000000000003842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
PURPOSE To describe photoreceptor damage in patients with Terson syndrome as a potential cause for inconsistent clinical outcomes. METHODS Clinical evaluation and retinal imaging in six patients. RESULTS Four patients were women and two men, with an average age of 46.8 years (SD 8.9). Four patients suffered aneurysmal subarachnoid hemorrhage, one vertebral artery dissection, and one superior sagittal sinus thrombosis. In 11 eyes, a consistent pattern of outer retinal changes within the central retina affecting the ellipsoid zone and the outer nuclear layer was observed, indicating photoreceptor damage. Areas of photoreceptor damage showed poor spatial correlation with intraocular hemorrhage, particularly subinternal limiting membrane hemorrhage. The observed retinal abnormalities demonstrated incomplete recovery over long-term follow-up 3.5 to 8 years posthemorrhage, irrespective of surgical or conservative treatment strategy, and had variable impact on the patients' visual function. CONCLUSION The observations suggest that photoreceptor damage in Terson syndrome likely represents a distinct manifestation of this condition, which could be caused by transient ischemia of the outer retina secondary to acute rise in intracranial pressure.
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Affiliation(s)
- Tomasz Szeligowski
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Dun J Fu
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Noa Fernandez-Ledo
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Johannes Birtel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; and
| | - Sher A Aslam
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Chetan K Patel
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Kanmin Xue
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
| | - Peter Charbel Issa
- Oxford Eye Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
- Nuffield Laboratory of Ophthalmology, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, United Kingdom
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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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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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Risk factors for macular pucker after rhegmatogenous retinal detachment surgery. Sci Rep 2021; 11:18276. [PMID: 34521926 PMCID: PMC8440624 DOI: 10.1038/s41598-021-97738-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/25/2021] [Indexed: 11/23/2022] Open
Abstract
Macular pucker, also known as an epiretinal membrane, sometimes forms after surgical repair of a rhegmatogenous retinal detachment (RRD) and can decrease visual acuity and cause aniseikonia. However, few reports are evaluating the risk factors of macular pucker using multivariate analysis. To evaluate the risk factors for macular pucker after RRD surgery, 226 patients who underwent RRD surgery and were monitored for greater than 12 months (23.2 ± 6.4 months) after surgery were analyzed retrospectively. Of these cases, macular pucker developed in 26 cases. Multiple logistic regression models of 22 clinical characteristics were performed. An increased risk of macular pucker after RRD surgery was significantly associated with preoperative vitreous haemorrhage (Odds ratio (OR), 4.71; 95% CI 1.19–18.62), multiple retinal breaks (OR, 8.07; 95% CI 2.35–27.71), re-detachment (OR, 19.66; 95% CI 4.87–79.38), and retinal detachment area (OR, 12.91; 95% CI 2.34–71.19). Macular pucker was not associated with the surgical technique. Regardless of the surgical technique used, careful observation for postoperative macular pucker is needed after RRD surgery in high-risk cases. These findings can be used to improve the surgical management of patients with RRD. (183 words).
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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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8
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Qi H, Yan H, Cheng Y, Zuo L. Macular hole with inner limiting membrane peeling off spontaneously in Terson syndrome: A case report. Medicine (Baltimore) 2021; 100:e25960. [PMID: 34087836 PMCID: PMC8183829 DOI: 10.1097/md.0000000000025960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/28/2021] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Terson's syndrome with inner limiting membrane (ILM) peeled off spontaneously is rarely seen, and the mechanism of it is not clear. Here we report a case of Terson Syndrome with a rare finding: the ILM peeled off spontaneously associated with macular hole (MH). PATIENT CONCERNS A 36-year-old female patient was admitted to our hospital with decreased visual acuity in the right eye lasting for 1 month. She just had surgery for subarachnoid hemorrhage that occurred 1 month before due to the rupture of the intracranial aneurysm. DIAGNOSIS Terson syndrome was diagnosed according to her medical history and examination. A partial posterior vitreous detachment (PVD) and dense vitreous hemorrhage (VH) was confirmed in the right eye by performing ophthalmic B-scan ultrasonography examination. Head computed tomography showed the subarachnoid hemorrhage after aneurysmal rupture. INTERVENTIONS The patient underwent pars plana vitrectomy in her right eye to remove the VH. After removal of the VH, a full-thickness macular hole was noted with the ILM peeled off spontaneously. So we conducted gas tamponade, and face-down positioning after pas plana vitrectomy. OUTCOMES At two weeks follow-up, her best corrected visual acuity was 0.15 in the right eye. Spectral domain optical coherence tomography showed that the MH was closed completely, while the thickness of the nasal retina of the foveal was thicker than that on the temporal side. LESSONS ILM peeled off spontaneously associated with MH is a rarely seen complication of Terson Syndrome. Due to the large-scale of the ILM peeling off, final visual acuity may be poor in patients, even though successful macular hole closure after the operation.
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Matsuoka T, Matsuda S, Harino S, Kumoi M, Tachibana E, Yokoyama J, Tsujino C, Kazuo K, Otori Y. Subarachnoid hemorrhage-negative Terson syndrome after intracranial artery treatment with a flow diverter device. Am J Ophthalmol Case Rep 2020; 20:100978. [PMID: 33163691 PMCID: PMC7599388 DOI: 10.1016/j.ajoc.2020.100978] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 10/07/2020] [Accepted: 10/18/2020] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To report a case of subarachnoid hemorrhage-negative Terson syndrome following intracranial artery treatment with flow diverter stents. OBSERVATIONS A 40-year-old Asian woman presented with floaters in her right eye after treatment of an intracranial aneurysm with flow diverter stents. Vitreous hemorrhage and sub-inner limiting membrane (sub-ILM) hemorrhage were present in her right eye. On fluorescein angiography, contrast perfusion and vascular occlusion were not noted. Magnetic resonance imaging (MRI) did not show any evidence of subarachnoid hemorrhage (SAH). We hypothesize that the bleeding was due to Terson syndrome associated with intracranial treatment with the flow diverter stents. During follow-up, the vitreous hemorrhage and sub-ILM hemorrhage disappeared, and the floaters in her vision improved. CONCLUSIONS AND IMPORTANCE This is the first reported case of vitreous hemorrhage and sub-ILM hemorrhage that should be considered to be Terson syndrome, after flow diverter stents treatment in the absence of SAH.
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Affiliation(s)
- Takanori Matsuoka
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Satoshi Matsuda
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Miho Kumoi
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Eri Tachibana
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Junko Yokoyama
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Chieko Tsujino
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Kumiko Kazuo
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Yasumasa Otori
- National Hospital Organization Osaka National Hospital, Osaka, Japan
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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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Ghoraba HH, Johnson MW, Leila M, Wasfy T, Ghoraba HH. Limited Vitrectomy versus Observation for Bilateral Terson Syndrome in a Child. Ophthalmol Retina 2020; 5:312-314. [PMID: 32920207 DOI: 10.1016/j.oret.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Revised: 08/31/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022]
Affiliation(s)
| | - Mark W Johnson
- Kellogg Eye Center, Department of Ophthalmology and Visual Sciences, University of Michigan, Ann Arbor, Michigan
| | - Mahmoud Leila
- Retina Department, Research Institute of Ophthalmology, Cairo, Egypt
| | - Tamer Wasfy
- Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Hammouda Hamdi Ghoraba
- Magrabi Eye Hospital, Tanta, Egypt; Department of Ophthalmology, Faculty of Medicine, Tanta University, Tanta, Egypt
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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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Kunle-Hassan F, Dattani M, Snead M, Subash M. BILATERAL INTRAOCULAR HEMORRHAGE SECONDARY TO CEREBRAL VENOUS SINUS THROMBOSIS. Retin Cases Brief Rep 2018; 12:216-218. [PMID: 27749748 DOI: 10.1097/icb.0000000000000458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
PURPOSE To report a case of bilateral intraocular hemorrhage secondary to cerebral venous sinus thrombosis with no associated intracranial hemorrhage. METHODS Case report. RESULTS A 32-year-old Asian gentleman presented with left reduced vision as a result of a left subhyaloid macular hemorrhage associated with severe headache. Right retinal hemorrhages were also present. Magnetic resonance imaging and computed tomography brain imaging demonstrated cerebral transverse venous sinus thrombosis. CONCLUSION Intraocular hemorrhage has previously been described in association with intracranial hemorrhage and in particular subarachnoid hemorrhage (Terson syndrome). We describe a similar clinical picture in the context of cerebral venous sinus thrombosis with no associated intracranial hemorrhage.
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Affiliation(s)
| | - Minaxi Dattani
- Luton and Dunstable University Hospital, Luton, United Kingdom
| | - Martin Snead
- Luton and Dunstable University Hospital, Luton, United Kingdom
- Addenbrookes Hospital, Cambridge, United Kingdom
| | - Mala Subash
- Luton and Dunstable University Hospital, Luton, United Kingdom
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Ramos-Estebanez C, Kohen M, Pace J, Bozorgi A, Manjila S, Alambyan V, Nwankwo I, DeGeorgia M, Bambakidis NC, Orge F. Bedside optical coherence tomography for Terson's syndrome screening in acute subarachnoid hemorrhage: a pilot study. J Neurosurg 2018; 130:517-524. [PMID: 29393753 DOI: 10.3171/2017.7.jns171302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Accepted: 07/24/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Approximately 10% of patients with subarachnoid hemorrhage (SAH) become permanently, legally blind. The average cost of lifetime support and unpaid taxes for each blind person amounts to approximately $900,000. This study evaluates the feasibility and potential role of bedside optical coherence tomography (OCT) in Terson’s syndrome (TS) in patients with acute SAH (aSAH) and its potential role in blindness prevention. METHODS The authors conducted an open-label pilot study, in which 31 patients with an angiographic diagnosis of aSAH were first screened for TS with dilated funduscopy and then with OCT in the acute phase and at 6-week followup visits. Outpatient mood assessments (Patient Health Questionnaire–depression module, Hamilton Depression Scale), and quality of life general (NIH Patient-Reported Outcomes Measurement Information System) and visual scales (25-item National Eye Institute Visual Functioning Questionnaire) were measured at 1 and 6 weeks after discharge. Exclusion criteria included current or previous history of severe cataracts, severe diabetic retinopathy, severe macular degeneration, or glaucoma. RESULTS OCT identified 7 patients with TS, i.e., a 22.6% incidence in our aSAH sample: 7 in the acute phase, including a large retinal detachment that was initially missed by funduscopy and diagnosed by OCT in follow-up clinic. Dilated retinal funduscopy significantly failed to detect TS in 4 (57.1%) of these 7 cases. Intraventricular hemorrhage was significantly more common in TS cases (85.7% vs 25%). None of the participants experienced any complications from OCT examinations. Neither decreased quality of life visual scale scores nor a depressed mood correlated with objective OCT pathological findings at the 6-week follow-up after discharge. There were no significant mood differences between TS cases and controls. CONCLUSIONS OCT is the gold standard in retinal disease diagnosis. This pilot study shows that bedside OCT examination is feasible in aSAH. In this series, OCT was a safe procedure that enhanced TS detection by decreasing false-negative/inconclusive funduscopic examinations. It allows early diagnosis of macular holes and severe retinal detachments, which require acute surgical therapy to prevent legal blindness. In addition, OCT aids in ruling out potential false-positive visual deficits in individuals with a depressed mood at follow-up.
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Affiliation(s)
| | - Maryo Kohen
- 2Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
| | | | | | | | | | | | | | | | - Faruk Orge
- 2Department of Ophthalmology, University Hospitals, Case Western Reserve University, Cleveland, Ohio
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Entezari M, Azhari S, Ramezani A. Fundus Findings in Spontaneous Subarachnoid Hemorrhage and their Correlation with Neurologic Characteristics. Eur J Ophthalmol 2018; 19:460-5. [DOI: 10.1177/112067210901900322] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Morteza Entezari
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University (M.C.), Tehran - Iran
| | - Shirzad Azhari
- Department of Neurosurgery, Imam Hossein Medical Center, Shahid Beheshti University (M.C.), Tehran - Iran
| | - Alireza Ramezani
- Department of Ophthalmology, Imam Hossein Medical Center, Shahid Beheshti University (M.C.), Tehran - Iran
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Traumatic subhyaloid macular hemorrhage with complete resolution following Neodymium-Doped Yttrium Aluminium Garnet Laser. Am J Ophthalmol Case Rep 2018; 9:85-87. [PMID: 29577097 PMCID: PMC5861631 DOI: 10.1016/j.ajoc.2018.01.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 01/06/2018] [Accepted: 01/09/2018] [Indexed: 11/20/2022] Open
Abstract
Purpose To report a case of traumatic subhyaloid macular hemorrhage with severe sudden vision loss treated successfully with Neodymium-Doped Yttrium Aluminium Garnet Laser (Nd:YAG laser). Observations A 16-year-old boy presented to the eye clinic with acute vision loss secondary to blunt trauma by a stone to his left eye 3 days prior to consultation that caused subhyaloid macular hemorrhage. Nd:YAG laser was performed to open the hyaloid membrane and allow the blood to diffuse into the vitreous cavity and be absorbed. The patient demonstrated complete recovery as his visual acuity went from counting fingers to 20/20 within 20 days. No complications due to the treatment were reported. Conclusions and importance To the best of our knowledge, there have been no reported cases of subhyaloid macular hemorrhage treated with Nd:YAG laser in which the etiology was trauma and showed full, rapid recovery with no sequelae.
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Sayman Muslubas I, Karacorlu M, Hocaoglu M, Ersoz MG, Arf S. Anatomical and functional outcomes following vitrectomy for dense vitreous hemorrhage related to Terson syndrome in children. Graefes Arch Clin Exp Ophthalmol 2017; 256:503-510. [DOI: 10.1007/s00417-017-3887-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Revised: 12/13/2017] [Accepted: 12/20/2017] [Indexed: 10/18/2022] Open
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Yoon HG, Kim DH. The Neuro-ophthalmic Presentation of Intracranial Aneurysms. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2017. [DOI: 10.3341/jkos.2017.58.11.1276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Han Gyul Yoon
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea
| | - Dae Hyun Kim
- Department of Ophthalmology, Chosun University School of Medicine, Gwangju, Korea
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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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Gogneaux L, Marks C, Defoort Dhellemmes S. Traumatisme crânien grave : intérêt d’un examen ophtalmologique dans les premiers temps : cas d’un syndrome de Terson bilatéral. J Fr Ophtalmol 2016; 39:e213-e216. [DOI: 10.1016/j.jfo.2015.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Revised: 06/03/2015] [Accepted: 06/11/2015] [Indexed: 10/20/2022]
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Zborowska B, Poon A, Retsas C. Pars Plana Vitrectomy for Terson's Syndrome—Visual Outcome and Impact on Postintracranial Hemorrhage Rehabilitation. Neurorehabil Neural Repair 2016. [DOI: 10.1177/154596839901300407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report the visual outcomes and change in the Modified Barthel Index Score (BIS) in four patients with Terson's syndrome treated with vitrectomy. A retrospective study of four patients with Terson's syndrome from Royal Prince Alfred Hospital, Sydney, was carried out. Assessment of visual acuity and physical disability pre- and post-vit rectomy using the Snellen Chart and the Barthel Index, respectively, was performed. All four patients were found to have improved visual acuity and BIS post vitrectomy. Improved vision from treatment of vitreous hemorrhage decreases the disability after intracranial hemorrhage and Terson's syndrome. Early diagnosis and management would shorten the rehabilitation process and improve the quality of life. Ophthalmo logic management depends on the severity of vitreous hemorrhage, whether it is uni lateral or bilateral, and its impact on patient's daily function. Key Words: Terson's syn drome—Subarachnoid hemorrhage—Vitreous hemorrhage—Vitrectomy—Visual acuity—Modified Barthel Score Index.
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Skevas C, Czorlich P, Knospe V, Stemplewitz B, Richard G, Westphal M, Regelsberger J, Wagenfeld L. Terson's Syndrome—Rate and Surgical Approach in Patients with Subarachnoid Hemorrhage. Ophthalmology 2014; 121:1628-33. [DOI: 10.1016/j.ophtha.2014.02.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Revised: 02/14/2014] [Accepted: 02/14/2014] [Indexed: 11/29/2022] Open
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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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Binenbaum G, Rogers DL, Forbes BJ, Levin AV, Clark SA, Christian CW, Liu GT, Avery R. Patterns of retinal hemorrhage associated with increased intracranial pressure in children. Pediatrics 2013; 132:e430-4. [PMID: 23878052 PMCID: PMC3727674 DOI: 10.1542/peds.2013-0262] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Raised intracranial pressure (ICP) has been proposed as an isolated cause of retinal hemorrhages (RHs) in children with suspected traumatic head injury. We examined the incidence and patterns of RHs associated with increased ICP in children without trauma, measured by lumbar puncture (LP). METHODS Children undergoing LP as part of their routine clinical care were studied prospectively at the Children's Hospital of Philadelphia and retrospectively at Nationwide Children's Hospital. Inclusion criteria were absence of trauma, LP opening pressure (OP) ≥ 20 cm of water (cm H2O), and a dilated fundus examination by an ophthalmologist or neuro-ophthalmologist. RESULTS One hundred children were studied (mean age: 12 years; range: 3-17 years). Mean OP was 35 cm H2O (range: 20-56 cm H2O); 68 (68%) children had OP >28 cm H2O. The most frequent etiology was idiopathic intracranial hypertension (70%). Seventy-four children had papilledema. Sixteen children had RH: 8 had superficial intraretinal peripapillary RH adjacent to a swollen optic disc, and 8 had only splinter hemorrhages directly on a swollen disc. All had significantly elevated OP (mean: 42 cm H2O). CONCLUSIONS Only a small proportion of children with nontraumatic elevated ICP have RHs. When present, RHs are associated with markedly elevated OP, intraretinal, and invariably located adjacent to a swollen optic disc. This peripapillary pattern is distinct from the multilayered, widespread pattern of RH in abusive head trauma. When RHs are numerous, multilayered, or not near a swollen optic disc (eg, elsewhere in the posterior pole or in the retinal periphery), increased ICP alone is unlikely to be the cause.
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Affiliation(s)
- Gil Binenbaum
- Division of Ophthalmology, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania 19104, USA.
| | - David L. Rogers
- Department of Ophthalmology, Nationwide Children’s Hospital, Columbus, Ohio
| | | | - Alex V. Levin
- Wills Eye Institute, Thomas Jefferson University, Philadelphia, Pennsylvania; and
| | - Sireesha A. Clark
- Department of Ophthalmology, Nationwide Children’s Hospital, Columbus, Ohio
| | - Cindy W. Christian
- Pediatrics, The Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Robert Avery
- Neurology and Pediatrics, Children’s National Medical Center, Washington, District of Columbia
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A perspective from magnetic resonance imaging findings of the inner ear: Relationships among cerebrospinal, ocular and inner ear fluids. Auris Nasus Larynx 2012; 39:345-55. [DOI: 10.1016/j.anl.2011.05.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2011] [Revised: 05/06/2011] [Accepted: 05/17/2011] [Indexed: 02/06/2023]
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Kim HS, Lee SW, Sung SK, Seo EK. Terson syndrome caused by intraventricular hemorrhage associated with moyamoya disease. J Korean Neurosurg Soc 2012; 51:367-9. [PMID: 22949967 PMCID: PMC3424178 DOI: 10.3340/jkns.2012.51.6.367] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2011] [Revised: 04/20/2012] [Accepted: 06/12/2012] [Indexed: 11/27/2022] Open
Abstract
Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. Terson syndrome can be caused by intracranial hemorrhage, subdural or epidural hematoma and severe brain injury but is extremely rare in intraventricular hemorrhage associated with moyamoya disease. A 41-year-old man presented with left visual disturbance. He had a history of intraventicular hemorrhage associated with moyamoya disease three months prior to admission. At that time he was in comatose mentality. Ophthalmologic examination at our hospital detected a vitreous hemorrhage in his left eye, with right eye remaining normal. Vitrectomy with epiretinal membrane removal was performed. After operation his left visual acuity was recovered. Careful ophthalmologic examination is mandatory in patients with hemorrhagic moyamoya disease.
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Affiliation(s)
- Ho Sang Kim
- Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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Obuchowska I, Turek G, Mariak Z, Kochanowicz J, Mariak Z. Late ophthalmological assessment of patients with subarachnoid hemorrhage and clipping of cerebral aneurysm. Acta Neurochir (Wien) 2011; 153:2127-36. [PMID: 21922215 DOI: 10.1007/s00701-011-1161-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 09/02/2011] [Indexed: 10/17/2022]
Abstract
PURPOSE To estimate prospectively late ocular manifestations in patients after aneurysmal subarachnoid hemorrhage (SAH) treated with aneurysm clipping. METHODS Forty-six patients (12 men and 34 women), 23-69 years of age, were included in this study. A conventional ophthalmological examination, visual evoked potentials (VEPs), and static perimetry were performed on all patients. The mean interval between the onset of SAH and the aforementioned examination was 1.9 ± 1.3 years (range 0.5-5 years). The following were compared between patients with affected and non-affected visual fields as well as between those with normal and abnormal VEPs: sex, age, time from SAH to surgery, Hunt and Hess scale, Glasgow Coma Scale, Glasgow Outcome Scale, grading of SAH according to the Fisher scale, and the size and site of aneurysm. RESULTS Visual field defects were found in 23 patients (50%). In all of these patients, both eyes were affected. The most frequent type of visual field defects were: constricted field (47.8%), multiple peripheral foci (26.1%), and superior field defect (17.4%). There was no significant relationship between the analyzed factors and the occurrence of visual field defects, although statistical significance was almost observed in respect to the Fisher scale (p = 0.055). Deterioration in VEPs was observed in nine patients (19.6%). In the group of patients with abnormal VEPs, the time from onset of SAH to surgery was 2.6 ± 1.8 days, whereas in the group of patients with normal VEPs this time amounted to 6.4 ± 2.4 days (p = 0.02). In patients with no changes in VEPs, the mean Fisher score was significantly higher than in the group with abnormal VEPs (2.8 ± 0.6 vs 2.0 ± 0.4 respectively, p = 0.04). CONCLUSION Visual field defects and VEP deterioration are frequent late ocular manifestations of SAH treated with aneurysm clipping. Damage to the visual pathway correlates with the severity of SAH and timing of aneurysmal surgery.
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Abstract
Papilledema has long been recognized as a valuable sign of increased intracranial pressure (ICP). But because papilledema is based on interruption of the energy-dependent process of axoplasmic flow, it appears late after a rise in ICP. Papilledema is usually present in chronically high ICP but sometimes asymmetrically in the 2 eyes and rarely in 1 eye only. Distinguishing it from other optic neuropathies that produce elevated optic discs is challenging, especially in the chronic phase, when visual function may be impaired. Papilledema is often an unrecognized cause of optic disc edema in inflammatory and compressive meningeal disorders that interfere with cerebrospinal fluid (CSF) passage through the arachnoid granulations. Its detection is particularly critical in patients with noncompliant ventricles or extraventricular blockage of cerebrospinal flow because imaging may fail to disclose conventional signs of high ICP. Therefore, patients with indwelling CSF shunts, tuberous sclerosis, chronic granulomatous meningitis, or meningiomatosis should be periodically examined for papilledema so that timely ICP-lowering measures can be instituted to preserve vision.
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Sung W, Arnaldo B, Sergio C, Juliana S, Michel F. Terson's syndrome as a prognostic factor for mortality of spontaneous subarachnoid haemorrhage. Acta Ophthalmol 2011; 89:544-7. [PMID: 20003110 DOI: 10.1111/j.1755-3768.2009.01735.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the prognosis of mortality in patients with spontaneous subarachnoid haemorrhage associated with Terson's syndrome. METHODS A prospective, consecutive case series study was conducted in patients admitted to the emergency room with a diagnosis of acute subarachnoid haemorrhage. After a complete neurological examination, funduscopic examination using binocular indirect ophthalmoscopy under mydriasis was performed upon admission and at days 3, 7, 30 and 60 after the onset. In all cases, the diagnosis of intracranial bleeding was made by computerized tomography, and the clinical condition was graded according to the Hunt & Hess and Glasgow coma scales. RESULTS Forty-seven patients with the diagnosis of subarachnoid haemorrhage were enrolled. Forty-four cases were associated with a ruptured aneurysm and three cases with arterio-venous malformation. Fourteen patients (29%) were diagnosed with Terson's syndrome. Seven patients (50%) with Terson's syndrome died, whereas death occurred in three patients (9%) without Terson's syndrome (p = 0.002). Ocular findings in Terson's syndrome were preretinal, intraretinal, sub-retinal and vitreous haemorrhage. Associated ocular findings included third-nerve palsy, papilloedema and subconjunctival haemorrhage. CONCLUSION The presence of Terson's syndrome was associated with an increased mortality rate (50% versus 9%; p < 0.01). Therefore, patients with the diagnosis of intracranial haemorrhage should be submitted to a funduscopic examination, because the presence of intraocular haemorrhage is an important life-threatening prognostic factor.
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Affiliation(s)
- Watanabe Sung
- Department of Ophthalmology, Federal University of São Paulo, Brazil.
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Michalewska Z, Michalewski J, Nawrocki J. Possible methods of blood entrance in Terson syndrome. Ophthalmic Surg Lasers Imaging Retina 2011; 41 Suppl:S42-9. [PMID: 21117599 DOI: 10.3928/15428877-20101031-15] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Accepted: 06/04/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND AND OBJECTIVE To present spectral domain optical coherence tomography (SD-OCT), scanning laser ophthalmoscopy, and intraoperative images showing possible pathways of blood entrance into the eye and ways in which it may spread inside the eye in Terson syndrome. PATIENTS AND METHODS Nine eyes of 5 patients with Terson syndrome underwent pars plana vitrectomy. Surgeries were recorded and analyzed afterward. SD-OCT and scanning laser ophthalmoscopy examinations were performed after surgery. RESULTS Visual acuity improved in all cases. SD-OCT three-dimensional mode improved visualization of the internal limiting membrane (ILM), possibly due to sub-ILM blood spreading detachment near the macula and optic disc. Scanning laser ophthalmoscopy revealed blood spreading along vessels and blood under the retina was observed intraoperatively. CONCLUSION SD-OCT, scanning laser ophthalmoscopy, and intraoperative images show that blood may enter the vitreous cavity around the retinal vessels near the optic disc. Inside the eye, the blood may spread intraretinally, sub-ILM, or along the retinal vessels.
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Ko F, Knox DL. The Ocular Pathology of Terson's Syndrome. Ophthalmology 2010; 117:1423-9.e2. [DOI: 10.1016/j.ophtha.2009.11.028] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2009] [Revised: 11/18/2009] [Accepted: 11/18/2009] [Indexed: 02/08/2023] Open
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Joondeph BC, Nguyen H, Politzer T, Weintraub A. Terson's Syndrome Managed with 25-Gauge Vitrectomy. Ophthalmic Surg Lasers Imaging Retina 2010; 41:1-3. [PMID: 20337288 DOI: 10.3928/15428877-20100215-85] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2009] [Indexed: 11/20/2022]
Abstract
Terson's Syndrome represents vitreous hemorrhage due to intracranial hemorrhage. A series of 18 adult eyes with Terson's Syndrome, due to either traumatic brain injury or ruptured aneurysm, successfully managed with 25-gauge vitrectomy was reported. All patients had improved vision, although some had limitation due to effects of surgery or the underlying pathology.
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Liu GT, Volpe NJ, Galetta SL. Optic disc swelling. Neuroophthalmology 2010. [DOI: 10.1016/b978-1-4160-2311-1.00006-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Chu ERL, Sandinha T, Lake S, Pater J. Terson Syndrome from a Significant Cerebral Infarct Occurring During the Peripartum Period. J Pediatr Ophthalmol Strabismus 2009. [PMID: 19873953 DOI: 10.3928/01913913-20091019-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2008] [Accepted: 06/17/2009] [Indexed: 11/20/2022]
Abstract
This case report describes a 23-day-old infant with significant infarct in the right middle cerebral artery territory associated with intraparenchymal hemorrhage within the infarct, subdural hygroma, and bilateral intraocular hemorrhage. The features, severity, and timing of the pathology are suggestive of Terson syndrome that has occurred during the peripartum period.
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Errera MH, Barale PO, Ounnoughene Y, Puech M, Sahel JA. [25-Gauge transconjunctival vitrectomy in a case of bilateral epiretinal membrane associated with a Terson syndrome]. J Fr Ophtalmol 2009; 32:268-72. [PMID: 19769858 DOI: 10.1016/j.jfo.2008.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Accepted: 12/18/2008] [Indexed: 11/29/2022]
Abstract
The formation of epiretinal membranes associated with proliferative vitreoretinopathy is known to be a complication of Terson syndrome. We report the first case of a 25-Gauge transconjunctival sutureless vitrectomy performed in one eye as treatment for an epiretinal membrane secondary to a case of Terson syndrome (most probably due to a history of subdural hematoma in childhood). Following a review of the current literature on the subject we report the physiopathologic mechanisms of Terson syndrome and the explanation for the proliferative vitreoretinopathy formation.
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Affiliation(s)
- M H Errera
- Service d'Ophtalmologie IV, CHNO des XV-XX, Paris, France.
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Hoving EW, Rahmani M, Los LI, Renardel de Lavalette VW. Bilateral retinal hemorrhage after endoscopic third ventriculostomy: iatrogenic Terson syndrome. J Neurosurg 2009; 110:858-60. [PMID: 19012481 DOI: 10.3171/2008.6.17610] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
A serious ophthalmological complication of an endoscopic third ventriculostomy that created an iatrogenic Terson syndrome is described. A patient with an obstructive hydrocephalus was treated endoscopically, but due to the inadvertent use of a pressure bag during rinsing, in combination with a blocked outflow channel, a steep rise in intracranial pressure occurred. Postoperatively the patient experienced disturbed vision caused by bilateral retinal hemorrhages, and an iatrogenic Terson syndrome was diagnosed. The pathogenesis of Terson syndrome is discussed based on this illustrative case.
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Affiliation(s)
- Eelco W Hoving
- Departments of Neurosurgery, University Medical Centre Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands.
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Abstract
PURPOSE There is no general agreement on the best indication and timing of vitrectomy in patients suffering from Terson syndrome. Therefore, we reviewed our cases in order to assess factors interfering with the functional outcome and complication rates after vitrectomy. METHODS In this retrospective consecutive case series, the records from all patients undergoing vitrectomy for Terson syndrome between 1975 and 2005 were evaluated. RESULTS Thirty-seven patients (45 eyes) were identified, 36 of whom (44 corresponding eyes) were eligible. The best-corrected visual acuity (BCVA) at first and last presentation was 0.07 +/- 0.12 and 0.72 +/- 0.31, respectively. Thirty-five eyes (79.5%) achieved a postoperative BCVA of > or = 0.5; 26 (59.1%) eyes achieved a postoperative BCVA of > or = 0.8. Patients operated on within 90 days of vitreous haemorrhage achieved a better final BCVA than those with a longer latency (BCVA of 0.87 +/- 0.27 compared to 0.66 +/- 0.31; P = 0.03). Patients younger than 45 years of age achieved a better final BCVA than older patients (0.85 +/- 0.24 compared to 0.60 +/- 0.33; P = 0.006). Retinal detachment developed in four patients between 6 and 27 months after surgery. Seven patients (16%) required epiretinal membrane peeling and seven cataract surgery. CONCLUSION Ninety-eight per cent of our patients experienced a rapid and persisting visual recovery after removal of a vitreous haemorrhage caused by Terson syndrome. A shorter time between occurrence of vitreous haemorrhage and surgery as well as a younger patient age are predictive of a better outcome. Generally, the surgical risk is low, but complications (namely retinal detachment) may occur late after surgery.
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Shin MK, Kim NM, Lee JE, Oum BS. Intravitreal Bevacizumab Injection as Preoperative Adjuvant of Vitrectomy for Proliferative Diabetic Retinopathy. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2009. [DOI: 10.3341/jkos.2009.50.5.731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Min Kyu Shin
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea
| | - Na Mi Kim
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea
| | - Ji Eun Lee
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
| | - Boo Sup Oum
- Department of Ophthalmology, School of Medicine, Pusan National University, Busan, Korea
- Medical Research Institute, Pusan National University, Busan, Korea
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Fountas KN, Kapsalaki EZ, Lee GP, Machinis TG, Grigorian AA, Robinson JS, Vergados I, Theodosiadis PG. Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: predisposing factors and prognostic significance. J Neurosurg 2008; 109:439-44. [PMID: 18759574 DOI: 10.3171/jns/2008/109/9/0439] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The association of vitreous and/or subhyaloid hemorrhage with aneurysmal subarachnoid hemorrhage (SAH) has been frequently identified since the original description by Terson in 1900. In this prospective clinical study the authors examined the actual incidence of Terson hemorrhage in patients suffering aneurysmal SAH, they attempted to identify those parameters that could predispose its development, and they evaluated its prognostic significance in the overall patients' outcome. METHODS A total of 174 patients suffering aneurysmal SAH were included in this study. The admitting Glasgow Coma Scale scores (GCS), World Federation of Neurological Societies (WFNS) scale scores, Hunt and Hess grades, and Fisher grades were recorded. A careful ophthalmological evaluation was performed in all participants. The exact anatomical locations and the largest diameter of the dome of the ruptured aneurysms were also recorded. Surgical clipping or endovascular coiling was used in 165 patients. Clinical outcome was evaluated at discharge from the hospital by using the Glasgow Outcome Scale and the modified Rankin Scale. Periodic ophthalmological evaluations were performed for 2 years. RESULTS In this series, the observed incidence of Terson hemorrhage was 12.1%. Statistical analysis of our data demonstrated that patients with low GCS scores and high WFNS scores, Hunt and Hess grades, and Fisher grades had an increased incidence of Terson hemorrhage. The mortality rate for patients with Terson hemorrhage was 28.6%, whereas that for patients without Terson hemorrhage was 2.0%. Moreover, patients with Terson hemorrhage who survived had significantly worse outcomes than those in patients without Terson hemorrhage. CONCLUSIONS 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.
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Affiliation(s)
- Kostas N Fountas
- Department of Neurosurgery, Attiko General Hospital of Athens, University of Athens, Greece.
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Lee SB, Kim SH, Kim JY. Full Thickness Macular Holes Associated with Terson Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2008. [DOI: 10.3341/jkos.2008.49.7.1194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Sung Bok Lee
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
| | - Sang Hyuk Kim
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Jung Yeul Kim
- Department of Ophthalmology, College of Medicine, Chungnam National University, Daejeon, Korea
- Chungnam National University Research Institute for Medical Sciences, Daejeon, Korea
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Sohn HJ, Nam DH. Postoperative Visual Recovery and Complications of Vitrectomy in Terson's Syndrome. JOURNAL OF THE KOREAN OPHTHALMOLOGICAL SOCIETY 2007. [DOI: 10.3341/jkos.2007.48.9.1242] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Hee Jin Sohn
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
| | - Dong Heun Nam
- Department of Ophthalmology, Gachon University Gil Medical Center, Incheon, Korea
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Tognetto D, Grandin R, Sanguinetti G, Minutola D, Di Nicola M, Di Mascio R, Ravalico G. Internal Limiting Membrane Removal during Macular Hole Surgery. Ophthalmology 2006; 113:1401-10. [PMID: 16877079 DOI: 10.1016/j.ophtha.2006.02.061] [Citation(s) in RCA: 128] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2005] [Revised: 02/17/2006] [Accepted: 02/21/2006] [Indexed: 02/03/2023] Open
Abstract
PURPOSE To evaluate the effect of internal limiting membrane (ILM) peeling and other variables in hole closure and functional success rate after idiopathic macular hole surgery. DESIGN Retrospective, multicenter, observational study. METHODS The records of 1627 patients operated on for idiopathic macular hole were collected retrospectively from 28 surgeons. All patients underwent a single pars plana vitrectomy and were divided into 2 groups: with and without ILM peeling. Preoperative, intraoperative, and postoperative variables were evaluated. RESULTS The overall rate of macular hole closure was 94.1% in the ILM peeling group and 89.0% in the no ILM peeling group (P<0.001). The probability of achieving hole closure after surgery is 2.59 times higher if the ILM is peeled (95% confidence interval [CI], 1.71-3.92; P<0.001), 3.12 times higher for holes lasting less than 6 months (95% CI, 1.70-5.71; P<0.001), 4.94 (95% CI, 2.39-10.20) for stage 2 holes, and 2.34 (95% CI, 1.55-3.53) for stage 3 holes than that of patients with a stage 4 hole (P<0.001). CONCLUSIONS Internal limiting membrane peeling seems to improve hole closure for stage 3 and 4 holes and for long-lasting holes. Higher-stage macular holes and longer duration of symptoms are risk factors for surgical failure. In patients obtaining hole closure, there is no difference in functional results between pseudophakic peeled and not peeled patients, whereas in phakic patients, a better functional result in not peeled patients was seen.
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Chong CT, Chin KJ, Yip LW, Singh K. Case series: Monocular visual loss associated with subarachnoid hemorrhage secondary to ruptured intracranial aneurysms. Can J Anaesth 2006; 53:684-9. [PMID: 16803916 DOI: 10.1007/bf03021627] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
PURPOSE To describe variations in the presentation of monocular visual loss associated with intracranial aneurysm rupture. The clinical course, possible etiologies and management of visual loss in three patients are described. CLINICAL FEATURES The first patient developed Terson's syndrome (vitreal hemorrhage associated with raised intracranial pressure secondary to subarachnoid hemorrhage). Following aneursymal clipping, her postoperative management was conservative and there was no improvement in visual acuity. The second patient underwent surgical clipping of internal carotid aneursysms and sustained visual loss subsequent to surgical dissection and temporary clipping around the optic nerve and anterior choroidal artery. The vessel subsequently thrombosed. Potential contributing factors to visual loss in this case included intraoperative hypotension and anemia. This patient received anti-platelet medications, and experienced subsequent improvement in visual acuity to 6/9. A third patient underwent a right orbito-frontal keyhole craniotomy with the cranial flap retracted across the orbit. Elevated intraocular pressure secondary to external orbital compression may have compromised retinal and choroidal perfusion. This patient also developed vasospasm of both anterior cerebral arteries which resolved partially with papaverine therapy. Hypertension-hypervolemia therapy was instituted, with subsequent partial recovery of visual acuity in her right eye. CONCLUSION Perioperative monocular visual loss associated with intracranial aneurysm repair is an infrequent occurrence, and clinical presentations may be quite variable. The primary pathophysiological mechanisms are intraocular hemorrhage and ischemia of ocular structures, including the optic nerve. Early detection, via regular fundoscopic examination and treatment aimed at decreasing intraocular pressure and augmenting ocular perfusion may improve outcomes.
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Affiliation(s)
- Chin Ted Chong
- Department of Anesthesiology, Tan Tock Seng Hospital, Singapore.
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Iwase T, Tanaka N. Bilateral subretinal haemorrhage with Terson's syndrome. Graefes Arch Clin Exp Ophthalmol 2005; 244:507-9. [PMID: 16133033 DOI: 10.1007/s00417-005-0105-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2005] [Revised: 06/11/2005] [Accepted: 07/18/2005] [Indexed: 10/25/2022] Open
Abstract
PURPOSE To present a case of Terson's syndrome with bilateral subretinal haemorrhage emanated from peripapilla, resulting in Mariotte blind spot enlargement. METHODS Preoperative CT scan and postoperative eye examinations, including funduscopy, fluorescein angiography, optical coherence tomography (OCT), and Goldmann perimetry. RESULTS A 41-year-old Japanese man had suffered a subarachnoid haemorrhage. Three months later, he recovered from disturbance of consciousness and was referred for decreased vision in both eyes. A CT scan, obtained on the day after the event, had revealed bilateral vitreous hemorrhage. The patient underwent a standard pars plana vitrectomy to clear vitreous haemorrhage. Surprisingly we found bilateral subretinal haemorrhage around peripapilla during surgery. Although subretinal haemorrhage was almost absorbed at six months after the operation, Mariotte blind spot enlargement corresponding to the area of subretinal haemorrhage was detected in both eyes. CONCLUSIONS In some population of the patients with Terson's syndrome, it was demonstrated that the disturbance of peripapillary structure, presumably due to intracranial hypertension, causes subretinal haemorrhage, resulting in irreversible visual field defect.
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Affiliation(s)
- Takeshi Iwase
- Department of Ophthalmology, Toyama Prefectural Central Hospital, 2-2-78 Nishinagae, Toyama City, Toyama, Japan.
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Stiebel-Kalish H, Turtel LS, Kupersmith MJ. The natural history of nontraumatic subarachnoid hemorrhage-related intraocular hemorrhages. Retina 2004; 24:36-40. [PMID: 15076942 DOI: 10.1097/00006982-200402000-00006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To describe the natural history of intraocular hemorrhages related to subarachnoid hemorrhage (SAH) as a result of ruptured intracranial aneurysms. METHODS Retrospective review of patients with cerebral aneurysms examined by a referral neuro-ophthalmology service between 1980 and 1998. Patients with intraocular hemorrhages associated with SAH as a result of ruptured aneurysms were followed up without vitrectomy, unless bilateral vitreous hemorrhage occurred. RESULTS Seventy of 450 patients with cerebral aneurysms had an SAH. Of these, 30 eyes of 19 patients had intraocular hemorrhages. Fourteen eyes had a vitreous hemorrhage; 12 had subhyaloid blood without a vitreous hemorrhage; and four had retinal hemorrhages alone. Two patients died shortly after presentation. Twenty-eight eyes were followed up for a mean of 4.8 years. Initial visual acuity was 20/100 to light perception in eyes with a vitreous hemorrhage, 20/20 to 20/400 in eyes with subhyaloid blood, and 20/20 to 20/40 in eyes with retinal hemorrhages. Three of the 12 eyes with a vitreous hemorrhage underwent vitrectomy. Of the nonoperated eyes, final visual acuity was at least 20/30 in 19 (76%) eyes, 20/40 to 20/60 in four (16%) eyes, and 20/100 in both eyes of one patient with premacular subhyaloid blood. None of the nonoperated eyes developed cataract formation or progression, retinal tears, or retinal detachment. Epiretinal membrane developed in one eye and pigmentary maculopathy developed in five. CONCLUSIONS Except for patients with bilateral vitreous hemorrhages, early vitrectomy may not be necessary in most cases of intraocular hemorrhages associated with nontraumatic SAH.
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Affiliation(s)
- Hadas Stiebel-Kalish
- Division of Neuro-ophthalmology, Department of Ophthalmology, Rabin Medical Center, Petah Tiqva 49100, Israel.
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Karacorlu M, Karacorlu S, Ozdemir H. Iatrogenic punctate chorioretinopathy after internal limiting membrane peeling. Am J Ophthalmol 2003; 135:178-82. [PMID: 12566021 DOI: 10.1016/s0002-9394(02)01925-6] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
PURPOSE To define the chorioretinal lesions created unintentionally during grasping the internal limiting membrane (ILM) with end-gripping forceps. DESIGN Interventional case series. METHODS A prospective review of a consecutive series of 15 patients (15 eyes) who underwent macular hole repair was performed. All patients underwent a three-port pars plana vitrectomy with ILM peeling. Fundus photographs, fluorescein angiography, and indocyanine green angiography were performed in all patients before and after surgery. RESULTS In all eyes, small punctate barely seen chorioretinal lesions in the macular region were detected after surgery. These punctate lesions corresponded to the area where ILM was grasped with forceps. The lesions ranged from 100 to 400 microm in diameter. Their number ranged between 8 and 15 (mean, 12.6). In the early phase of fluorescein angiography, the lesions appeared hypofluorescent; in the late phase, there was slight staining of the margin of the lesions extending from the adjacent choriocapillaris, causing indistinct borders. In the early phase of indocyanine green angiogram, the lesions were hypofluorescent and in some larger lesions choroidal vessels were visible due to the thinning and atrophy of the retinal pigment epithelium and choriocapillaris. In the late phase, the homogenous hypofluorescent areas had well-delineated margins and were usually round or oval. This angiographic finding was independent of the age of the lesion, and neither enlargement of the lesions nor development of choroidal neovascularization were noted during follow-up. CONCLUSIONS Iatrogenic punctate chorioretinopathy is the chorioretinal lesion created unintentionally during grasping the ILM with end-gripping forceps. It must be reported as one of the complications of ILM peeling. These small punctate lesions did not appear to affect the surgical outcome. However, the lesions should be followed to detect any long-term complication such as choroidal neovascularization.
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