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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: 2] [Impact Index Per Article: 2.0] [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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Mazza JM, Tank P, LoPresti MA, Scoville JP, Bohnsack BL, Lam S. Terson syndrome secondary to aneurysmal subarachnoid hemorrhage in a child: illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2023; 5:CASE2390. [PMID: 37354431 PMCID: PMC10550527 DOI: 10.3171/case2390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/01/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND Terson syndrome is the phenomenon of intraocular hemorrhage in the setting of subarachnoid hemorrhage (SAH). Vision loss can lead to morbidity for the affected individual. Aneurysmal SAH related to intracranial aneurysms is rare in children. Studies have shown the incidence of Terson syndrome in adults with aneurysmal SAH to be over 40%; however, few cases of Terson syndrome in pediatric aneurysmal SAH have been reported. OBSERVATIONS A 9-year-old male presented with altered mental status and seizures. Computed tomographic angiography showed aneurysmal SAH from a ruptured, left-sided posterior inferior cerebellar artery aneurysm. The patient underwent endovascular treatment with coiling and external ventricular drainage for SAH. Ophthalmological consultation for blurry vision revealed the diagnosis of Terson syndrome with decreased vision in the left eye, which was managed conservatively. LESSONS Terson syndrome after SAH can occur in children. Prompt ophthalmological evaluation in pediatric patients with aneurysmal SAH is vital for recognition and management to decrease overall morbidity.
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Affiliation(s)
- Jacob M. Mazza
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Parth Tank
- Chicago Medical School of Rosalind Franklin University, Chicago, Illinois
| | - Melissa A. LoPresti
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Jonathan P. Scoville
- Department of Neurological Surgery, University of Utah School of Medicine, Salt Lake City, Utah; and
| | - Brenda L. Bohnsack
- Division of Pediatric Ophthalmology, Department of Ophthalmology, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Sandi Lam
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Lurie Children’s Hospital, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Lima-Fontes M, Leuzinger-Dias M, Rodrigues R, Barros-Pereira R, Falcão M, Fernandes V, Alves-Faria P, Falcão-Reis F, Rocha-Sousa A. Terson Syndrome - Clinical Presentation, Management, and Visual Outcomes in a Tertiary Centre. Clin Ophthalmol 2023; 17:351-359. [PMID: 36721665 PMCID: PMC9884450 DOI: 10.2147/opth.s396781] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 01/09/2023] [Indexed: 01/27/2023] Open
Abstract
Purpose The purpose of this study was to characterize the clinical presentation, management strategy and visual outcomes of patients diagnosed with Terson syndrome and followed in a tertiary centre in Portugal. Patients and Methods A single-centre retrospective study was performed, based on the survey review of the medical records of every consecutive patient diagnosed with Terson syndrome and followed from January 2018 to August 2021. The change in best-corrected visual acuity (BCVA) from baseline to the final evaluation was the primary outcome. Results Fifteen eyes from 8 patients (50% female) were included. The mean age at diagnosis was 55±7 years. The neurological event was traumatic brain injury in 37.5% (n=3) and subarachnoid haemorrhage in 62.5% of the patients (n=5). Bilateral intraocular haemorrhage occurred in 875% (n=7) of the patients. Vitreous and preretinal haemorrhages occurred each in 66.7% (n=10), intraretinal in 30% (n=3) and subretinal in 13.3% (n=2) of the eyes. In 40% of the eyes (n=6), spontaneous resolution of intraocular haemorrhage occurred, while PPV was performed in the remaining 60% (n=9). Ocular haemorrhage detection occurred 58.47 ± 40.94 days after the neurological event (range 11 to 121 days). Baseline BCVA was 1.11 ± 1.01 logMAR and improved to 0.32 ± 0.69 logMAR in the follow-up period (p=0.004). A positive correlation was found between initial and final BCVA (Spearman's rho = 0.643, p=0.01). Baseline BCVA of eyes undergoing PPV was lower than of those conservatively managed (1.84±0.72 vs 0.20±0.28 logMAR, p<0.001). However, there were no statistically significant differences in final BCVA after surgery or observation (0.56 ± 0.90 vs 0.04 ± 0.04 logMAR, p=0.149). Longer periods between the neurological and the ophthalmological diagnosis were correlated with worse final BCVA (Spearman's rho = 0.688, p=0.005). Conclusion Terson syndrome is a potential cause of irreversible visual loss. Diagnosis delay may affect visual prognosis. PPV is indicated when intraocular haemorrhage is dense and does not resolve spontaneously or when visual acuity at presentation is low, allowing for good visual outcomes with minimal complications.
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Affiliation(s)
- Mario Lima-Fontes
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Correspondence: Mario Lima-Fontes, Department of Ophthalmology, Alameda Prof. Hernâni Monteiro, Porto, 4200-319, Portugal, Email
| | - Mariana Leuzinger-Dias
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Rita Rodrigues
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Ricardo Barros-Pereira
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Manuel Falcão
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| | - Vítor Fernandes
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal
| | - Pedro Alves-Faria
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| | - Fernando Falcão-Reis
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
| | - Amândio Rocha-Sousa
- Ophthalmology Department, Centro Hospitalar Universitário São João, Porto, 4200-319, Portugal,Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Porto, 4200-319, Portugal
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Zhaba WD, Deji QZ, Deng HJ, Han YL, Gao SQ, Liu XL, Zhou ML. Retinal hypoxia after experimental subarachnoid hemorrhage. Neurosci Lett 2020; 742:135554. [PMID: 33352284 DOI: 10.1016/j.neulet.2020.135554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/17/2020] [Accepted: 12/02/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND AND PURPOSE The patients who survive subarachnoid hemorrhage (SAH) often have long-term neurological complications. There are no reports about the pathological change of retina after SAH. METHODS An experimental model of SAH was established by injecting autologous blood into the prechiasmatic cistern of Sprague-Dawley rats. Hematoxylin and eosin (HE) staining was performed to show the alternation of morphology in retina after SAH. To detect the retinal new vessels (NVs), CD31 was labelled by immunofluorescence and immunohistochemistry. The time-course expressions of vascular endothelial growth factor (VEGF)-A and hypoxia-inducible factor-1α (HIF-1 α) was also revealed by Western blot analysis. RESULTS A clear reduction of retinal ganglion cells (RGCs) was noticed after SAH. The immunofluorescence and immunohistochemical staining of CD31 reveals a large number of NVs in RGC layer after SAH compared with the normal controls. The level of VEGF-A in the retina after SAH was increased and peaked at 12h and 14 d. The expression of HIF-1α in the retina increased as early as 3 h after SAH, reached a peak at 12 h after SAH. CONCLUSIONS The results showed that SAH induced the retina hypoxia resulting in the reduction of RGCs, increase of NVs and activation of NVs related HIF-1α/VEGF-A pathway.
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Affiliation(s)
- Wang-Dui Zhaba
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Qu-Zhen Deji
- Department of Ophthalmology, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Hong-Ji Deng
- Department of Neurosurgery, The First Affiliated Hospital, Guangxi Medical University, Nanning, Guangxi, China
| | - Yan-Ling Han
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Sheng-Qing Gao
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Xi-Lin Liu
- Graduate School of Wannan Medical College, Wuhu, Anhui, China
| | - Meng-Liang Zhou
- Department of Neurosurgery, Jinling Hospital, Medical School of Nanjing University, Nanjing, China.
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