Vitreous Hemorrhage after Aneurismal Rupture: Terson SyndromeArticle in several languages: English | português
16 November 2015
02 February 2016
14 April 2016 (online)
Introduction Terson syndrome is described as an intraocular hemorrhage consequent to a spontaneous subarachnoid hemorrhage (SSAH). In the present article, we describe cases of patients who underwent neurosurgical treatment of ruptured cerebral aneurysm at our institution over a period of one year, and who were diagnosed with Terson syndrome.
Methods The present study included patients with a diagnosis of SSAH by rupture of a cerebral aneurysm who underwent treatment in our neurosurgical service from December 2009 to December 2010. The patients were followed-up for a minimum of 20 months. We have also performed a literature review and compared the data with those available in the current literature.
Results The present study included 34 patients, 18 (53%) of which underwent endovascular treatment, and 16 (47%) who underwent microsurgical clipping. In the sample, the mortality was 14.7% (5 patients), the same percentage of patients who were diagnosed with Terson Syndrome, which is an incidence of 14.7%. Regarding the ophthalmologic evaluation, all patients had vitreous hemorrhage detected by an ultrasound examination, which was unilateral in only two patients. Visual acuity improved in all patients, being incomplete in only one of them.
Conclusion Terson syndrome is relatively common and is associated with higher mortality. With the existence of an effective treatment, it should be investigated in all patients with SSAH.
- 1 McCarron MO, Alberts MJ, McCarron P. A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 2004; 75 (03) 491-493
- 2 Terson A. De L'hémorrhagie dans Le corps vitre au cours de L'émorrhagie cerebrale. Clin Ophthalmol 1900; 6: 309-312
- 3 Fahmy JA. Fundal haemorrhages in ruptured intracranial aneurysms. I. Material, frequency and morphology. Acta Ophthalmol (Copenh) 1973; 51 (03) 289-298
- 4 Garfinkle AM, Danys IR, Nicolle DA, Colohan AR, Brem S. Terson's syndrome: a reversible cause of blindness following subarachnoid hemorrhage. J Neurosurg 1992; 76 (05) 766-771
- 5 Fountas KN, Kapsalaki EZ, Lee GP. , et al. Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: predisposing factors and prognostic significance. J Neurosurg 2008; 109 (03) 439-444
- 6 He T, Wu LN, Chen B, Xing YQ. [Incidence and relative factors of Terson syndrome in patients with aneurysmal subarachnoid hemorrhage]. Zhonghua Yan Ke Za Zhi 2011; 47 (12) 1096-1101
- 7 Doubler FH, Marlow SB. A case of hemorrhage into the optic nerve sheath as a direct extension from a diffuse intra-meningeal hemorrhage caused by rupture of an aneurysm of a cerebral artery. Arch Ophthalmol 1917; 46: 533-536
- 8 Medele RJ, Stummer W, Mueller AJ, Steiger HJ, Reulen HJ. Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure. J Neurosurg 1998; 88 (05) 851-854
- 9 Castren JA. Pathogenesis and treatment of Terson-syndrome. Acta Ophthalmol (Copenh) 1963; 41: 430-434
- 10 Riddoch G, Goulden C. On the relationship between subarachnoid and intraocular haemorrage. Br J Ophthalmol 1925; 9 (05) 209-233
- 11 Manschot WA. The fundus oculi in subarachnoid haemorrhage. Acta Ophthalmol (Copenh) 1944; 22: 281-299
- 12 Shaw Jr HE, Landers MB, Sydnor CF. The significance of intraocular hemorrhages due to subarachnoid hemorrhage. Ann Ophthalmol 1977; 9 (11) 1403-1405
- 13 Shaw Jr HE, Landers III MB. Vitreous hemorrhage after intracranial hemorrhage. Am J Ophthalmol 1975; 80 (02) 207-213
- 14 Körner F, Meier-Gibbons F. [Vitrectomy in Terson syndrome. Report of 18 cases]. Klin Monatsbl Augenheilkd 1992; 200 (05) 468-471 (Ger.)
- 15 Roux FX, Panthier JN, Tanghe YM. , et al. [Terson's syndrome and intraocular complications in meningeal hemorrhages (26 cases)]. Neurochirurgie 1991; 37 (02) 106-110
- 16 Schultz PN, Sobol WM, Weingeist TA. Long-term visual outcome in Terson syndrome. Ophthalmology 1991; 98 (12) 1814-1819
- 17 Garweg JG, Koerner F. Outcome indicators for vitrectomy in Terson syndrome. Acta Ophthalmol 2009; 87 (02) 222-226