1
|
Vassilopoulos T, Tsitsipanis C, Stavrakakis A, Ntotsikas K, Moustakis N, Theofanopoulos AK, Lazarioti S, Bartsokas C, Raouzaiou KM, Trikkos A, Kritikou G, Konidis E, Tsilimbaris MK, Yannopoulos A. A 52-Year-Old Man with Aneurysmal Subarachnoid Hemorrhage Associated with Delayed-Onset Vitreous Hemorrhage (Terson's Syndrome) Successfully Treated with Balloon-Assisted Coiling and Delayed Vitrectomy. AMERICAN JOURNAL OF CASE REPORTS 2024; 25:e943567. [PMID: 39086102 PMCID: PMC11330943 DOI: 10.12659/ajcr.943567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 06/29/2024] [Accepted: 05/02/2024] [Indexed: 08/02/2024]
Abstract
BACKGROUND Terson's syndrome (TS) is a medical condition characterized by intraocular bleeding that can lead to visual impairment and is associated to subarachnoid hemorrhage (SAH). The pathophysiology and natural history are not well established in the current literature. This report describes successful treatment of a 52-year-old man with aneurysmal SAH who developed late-onset TS using balloon-assisted coiling and vitrectomy to raise awareness of this important complication of aneurysmal SAH. CASE REPORT A 52-year-old smoker with no known past medical history presented to the emergency department with a sudden, severe headache that worsened with photophobia and phonophobia. The patient had a diffuse SAH and underwent an embolization procedure. After 48 hours of close Intensive Care Unit monitoring, the patient's vital signs were stable, and the GCS score was consistently 15/15. However, after 3 weeks in the hospital, the patient experienced blurred vision and a right upper quadrantanopia. Further examination revealed TS and the patient underwent a vitrectomy in 1 eye. The surgery was successful and the eye recovered to 20/20 with no complications. However, the other eye showed slow absorption of the hemorrhage, and a vitrectomy was scheduled for that eye as well. CONCLUSIONS TS is a complication of aneurysmal SAH that can lead to vision loss and increased morbidity. It often goes undiagnosed, and ophthalmologists are not regularly consulted. Late manifestation of the condition is exemplified by the present case. Early detection and intervention are crucial for better patient outcomes.
Collapse
Affiliation(s)
| | - Christos Tsitsipanis
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Anastasios Stavrakakis
- Department of Ophthalmology, General University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Konstantinos Ntotsikas
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Nikolaos Moustakis
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | - Sofia Lazarioti
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Crete, Greece
| | | | | | | | - Georgia Kritikou
- Department of Surgical Oncology, General University Hospital of Heraklion, Heraklion Crete, Greece
| | | | - Miltiadis K. Tsilimbaris
- School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Ophthalmology, General University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Andreas Yannopoulos
- Department of Neurosurgery, General University Hospital of Heraklion, Heraklion, Crete, Greece
| |
Collapse
|
2
|
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: 21] [Impact Index Per Article: 7.0] [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.
Collapse
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.
| |
Collapse
|
3
|
Liu Y, Wang J, Lin L, Sang C, Lin Z, Pan Y, Fu X. Clinical Study on Complications of Intracranial Ruptured Aneurysm Embolization by Stent-Assisted Coil. Med Sci Monit 2018; 24:8115-8124. [PMID: 30419569 PMCID: PMC6243916 DOI: 10.12659/msm.911773] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Background The aim of this study was to retrospectively analyze the incidence of complications of intracranial complex aneurysms embolization by stent-assisted coils, and to investigate the causes of complications and corresponding treatment methods. Material/Methods A total of 71 patients with subarachnoid hemorrhage (SAH) underwent stent-assisted coil embolization from 2015 to 2018 were enrolled in this study. Among them, 59 cases were single aneurysm, 12 cases were multiple aneurysms (11 cases with 2 aneurysms and 1 case with 3 aneurysms), for a total of 84 aneurysms. All enrolled patients received stent angioplasty except for 1 case. Results There were 62 aneurysms (73.81%) treated with complete tamponade, 21 aneurysms (25.00%) treated with near-total tamponade and 1 aneurysm (1.19%) treated with partial tamponade. All aneurysms were evaluated based on GOS (Glascow outcome scale): 55 cases had GOS of 5 scores, 12 cases had GOS of 4 scores, 3 cases had GOS of 3 scores, and 1 case had GOS of 1 score. There were 67 SAH patients with good prognosis (GOS of 4–5 scores). In our study, the incidence of complications was 12.7%. Three cases experienced acute thrombosis, 2 cases experienced aneurysm rupture during embolization, and 1 case experienced postoperative focal ischemic changes with mild neurological deficits. Conclusions Stent-assisted coil embolization is safe, effective, and feasible for the treatment of intracranial ruptured aneurysms. Patients had a favorable outcome of as high as 94.4%. However, clinical skills should be improved to reduce the occurrence of complications. Prompt and timely treatment for complications of intracranial ruptured aneurysm is also of great significance.
Collapse
Affiliation(s)
- Yinlong Liu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
| | - Jianren Wang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
| | - Liqing Lin
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
| | - Chunsheng Sang
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
| | - Zexi Lin
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
| | - Yaohua Pan
- Department of Neurosurgery, Renji Hospital Affiliated to Shanghai Jiaotong University, Shanghai, China (mainland)
| | - Xi'an Fu
- Department of Neurosurgery, The Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou Municipal Hospital, Suzhou, Jiangsu, China (mainland)
| |
Collapse
|
4
|
Conzen C, Albanna W, Weiss M, Kürten D, Vilser W, Kotliar K, Zäske C, Clusmann H, Schubert GA. Vasoconstriction and Impairment of Neurovascular Coupling after Subarachnoid Hemorrhage: a Descriptive Analysis of Retinal Changes. Transl Stroke Res 2017; 9:284-293. [PMID: 29119370 DOI: 10.1007/s12975-017-0585-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 10/24/2017] [Accepted: 10/31/2017] [Indexed: 11/25/2022]
Abstract
Impaired cerebral autoregulation and neurovascular coupling (NVC) contribute to delayed cerebral ischemia after subarachnoid hemorrhage (SAH). Retinal vessel analysis (RVA) allows non-invasive assessment of vessel dimension and NVC hereby demonstrating a predictive value in the context of various neurovascular diseases. Using RVA as a translational approach, we aimed to assess the retinal vessels in patients with SAH. RVA was performed prospectively in 24 patients with acute SAH (group A: day 5-14), in 11 patients 3 months after ictus (group B: day 90 ± 35), and in 35 age-matched healthy controls (group C). Data was acquired using a Retinal Vessel Analyzer (Imedos Systems UG, Jena) for examination of retinal vessel dimension and NVC using flicker-light excitation. Diameter of retinal vessels-central retinal arteriolar and venular equivalent-was significantly reduced in the acute phase (p < 0.001) with gradual improvement in group B (p < 0.05). Arterial NVC of group A was significantly impaired with diminished dilatation (p < 0.001) and reduced area under the curve (p < 0.01) when compared to group C. Group B showed persistent prolonged latency of arterial dilation (p < 0.05). Venous NVC was significantly delayed after SAH compared to group C (A p < 0.001; B p < 0.05). To our knowledge, this is the first clinical study to document retinal vasoconstriction and impairment of NVC in patients with SAH. Using non-invasive RVA as a translational approach, characteristic patterns of compromise were detected for the arterial and venous compartment of the neurovascular unit in a time-dependent fashion. Recruitment will continue to facilitate a correlation analysis with clinical course and outcome.
Collapse
Affiliation(s)
- Catharina Conzen
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Walid Albanna
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Miriam Weiss
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - David Kürten
- Department of Ophthalmology, RWTH Aachen University, Aachen, Germany
| | | | - Konstantin Kotliar
- Department of Medical Engineering and Technomathematics, FH Aachen University of Applied Sciences, Aachen, Germany
| | - Charlotte Zäske
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Pauwelsstr. 30, 52074, Aachen, Germany
| | | |
Collapse
|