Terson-Syndrom – ein vernachlässigtes Problem?

Zusammenfassung

Hintergrund: Ziel unserer Studie war die Analyse der Inzidenz und des prognostischen Wertes intraokularer Blutungen als Folge von Subarachnoidalblutungen.

Patienten und Methode: Retrospektive Auswertung der Daten aller zwischen 2005 und 2010 mit einer Subarachnoidalblutung im Universitätsspital Zürich hospitalisierten Patienten. Alle Patienten wurden anhand der Glasgow-Koma-, Hunt-und-Hess-, WFNS- und Fisher-Skalen klassifiziert.

Ergebnisse: Von 391 Patienten waren lediglich 26 ophthalmologisch untersucht worden. Von diesen zeigten 11/26 (42 %) ein Terson-Syndrom, verglichen mit 11/391 (2,8 %) über die gesamte Kohorte. Patienten mit Intraokularblutung zeigten einen Trend zu tieferen GCS-Werten und höheren Hunt-und-Hess-, WFNS- und Fisher-Graden.

Schlussfolgerung: Intraokularblutungen sind eine häufige, scheinbar jedoch wenig beachtete Komplikation von Subarachnoidalblutungen und korrelieren in prospektiven Studien mit höherer Mortalität und Morbidität. Eine routinemäßige Funduskopie der schwer beeinträchtigten Patienten sollte erwogen werden.

Abstract

Background: The aim of our study was to analyze the incidence and prognostic value of intraocular hemorrhages caused by subarachnoid hemorrhages.

Patients and Methods: Retrospective data analysis of all patients with subarachnoid hemorrhage admitted to the University Hospital Zurich between 2005 and 2010. All patients have been classified according to Glasgow Coma, Hunt and Hess, WFNS and Fisher Scales.

Results: Out of 391 patients only 26 have been examined by an ophthalmologist. 11/26 (42 %) showed Tersonʼs syndrome, compared to 11/391 (2.8 %) in the overall cohort. In patients with intraocular hemorrhages there was a trend for a lower GCS and higher Hunt and Hess, WFNS and Fisher scales.

Conclusion: Intraocular hemorrhages are a relatively frequent, seemingly neglected complication of subarachnoid hemorrhages, and correlate with a higher mortality and morbidity in prospective studies. Routine fundoscopy of heavily impaired patients should be considered.

Schlüsselwörter

Subarachnoidalblutung - Terson-Syndrom - intraokulare Blutung

Key words

subarachnoid hemorrhage - Tersonʼs syndrome - intraocular hemorrhage

• Literatur

• 1 Suarez JI, Tarr RW, Selman WR. Aneurysmal subarachnoid hemorrhage. N Engl J Med 2006; 354: 387-396
• 2 Fountas KN. Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: predisposing factors and prognostic significance. J Neurosurg 2008; 109: 439-444
• 3 Medele RJ. Tersonʼs syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure. J Neurosurg 1998; 88: 851-854
• 4 Ogawa T. Terson syndrome: a case report suggesting the mechanism of vitreous hemorrhage. Ophthalmology 2001; 108: 1654-1656
• 5 Frizzell RT. Screening for ocular hemorrhages in patients with ruptured cerebral aneurysms: a prospective study of 99 patients. Neurosurgery 1997; 41: 529-533
• 6 Garfinkle AM. Tersonʼs syndrome: a reversible cause of blindness following subarachnoid hemorrhage. J Neurosurg 1992; 76: 766-771
• 7 Pfausler B. Tersonʼs syndrome in spontaneous subarachnoid hemorrhage: a prospective study in 60 consecutive patients. J Neurosurg 1996; 85: 392-394
• 8 Shaw HE, Landers MB, Sydnor CF. The significance of intraocular hemorrhages due to subarachnoid hemorrhage. Ann Ophthalmol 1977; 9: 1403-1405
• 9 Sung W. Tersonʼs syndrome as a prognostic factor for mortality of spontaneous subarachnoid haemorrhage. Acta Ophthalmol 2011; 89: 544-547
• 10 Ness T, Janknecht P, Berghorn C. Frequency of ocular hemorrhages in patients with subarachnoidal hemorrhage. Graefes Arch Clin Exp Ophthalmol 2005; 243: 859-862
• 11 Manschot WA. Subarachnoid hemorrhage; intraocular symptoms and their pathogenesis. Am J Ophthalmol 1954; 38: 501-505
• 12 Vanderlinden RG, Chisholm LD. Vitreous hemorrhages and sudden increased intracranial pressure. J Neurosurg 1974; 41: 167-176
• 13 Swallow CE. Terson syndrome: CT evaluation in 12 patients. AJNR Am J Neuroradiol 1998; 19: 743-747
• 14 Wietholter S, Steube D, Stotz HP. Terson syndrome: a frequently missed ophthalmologic complication in subarachnoid hemorrhage. Zentralbl Neurochir 1998; 59: 166-170
• 15 Garweg JG, Koerner F. Outcome indicators for vitrectomy in Terson syndrome. Acta Ophthalmol 2009; 87: 222-226
• 16 Hunt WE, Hess RM. Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg 1968; 28: 14-20
• 17 Teasdale GM, Drake CG, Hunt W et al. A universal subarachnoid hemorrhage scale: report of a committee of the World Federation of Neurological Societies. J Neurol Neurosurg Psychiatry 1988; 51: 1457
• 18 Fisher CM, Kistler JP, Davis JM. Relation of cerebral vasospasm to subarachnoid hemorrhage visualized by computerized tomographic scanning. Neurosurgery 1980; 6: 1-9