Terson syndrome with persistent vitreous hemorrhage following traumatic brain injury. Three case reports of terson syndrome in babies, from 5 weeks to 7 months old, due to a ruptured angiodysplasia or an aneurysma have been published. A case of tersonlike syndrome in a patient with viral. We therefore designed a prospective singleblinded study to evaluate the validity of ocular ultrasound compared to the gold standard indirect funduscopy in the diagnosis of tersons syndrome. Terson syndrome and subarachnoid hemorrhage eccles. Ocular ultrasound as an easy applicable tool for detection. One does need to consider other causes of this condition in the differential diagnosis.
Terson syndrome is defined as intraocular hemorrhage associated with. This case shows an extensive subarachnoid hemorrhage with blood in the posterior globe. In this syndrome, vitreous or retinal hemorrhage results from an abrupt rise in intracranial pressure, leading to retinal venous hypertension and intraocular hemorrhage. Our objective was to determine whether imaging findings could be discovered that. Terson syndrome now encompasses any intraocular hemorrhage. The proposed mechanism of tersons syndrome is increased intracranial pressure that leads to dilation of the retrobulbar optic nerve and compression of the central retinal vein. In one eye blood was suddenly spontaneously absorbed after four months. Vitreous hemorrhage of the eye can also occur in association with intracranial hemorrhage and elevated intracranial pressure icp. Tersons syndrome has been associated with many conditions that increase intracranial pressure such as venous sinus thrombosis, moyamoya disease, leukemia, direct head trauma, and intraocular hemorrhage. Ruptured aneurysm and terson syndrome in a 1monthold.
View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Herein, we report a case of arn with atypical clinical features combined with tersons syndrome that we successfully treated by intravitreal ganciclovir injection. Terson syndrome caused by intraventricular hemorrhage. Most cases of tersons syndrome involve patients who have had subarachnoid hemorrhages. Terson syndrome can be an important marker to assess patients outcome. This article is from clinical ophthalmology auckland, n. Ct head scan revealed a tentorial acute subdural hemorrhage asdh and posterior globe hyperdensities suggestive of intraocular blood with a right posterior communicating artery aneurysm on cerebral angiography figure 1. Conclusions tersons syndrome occurs frequently following sah, although it is underreported. We present the case of a 7monthold female infant who was found crying and limp. She was transported to a hospital where a possible subarachnoid hemorrhage was diagnosed radiologically. In approximately onethird of these eyes, a premacular accumulation of blood termed a hemorrhagic macular cyst hmc may be. Terson syndrome terson, vitreous, retinal, and subhyaloid hemorrhages associated with subarachnoid hemorrhage.
Acute vision loss secondary to epidural blood patch. The report by schultz et al entitled, longterm visual outcome in terson syndrome ophthalmology 1991. We describe six eyes from three patients with terson syndrome. Incidence of terson syndrome in treated subarachnoid. Two reports appeared to be from the same cohort of patients.
There were more than twice as many women as men, a finding consistent with the sex. Ophthalmologic assessment confirmed terson syndrome figure 2. The combination of these features is known as terson syndrome subarachnoid hemorrhage has multiple grading systems, both clinically and radiologically based. Tersons syndrome is vitreous hemorrhage occurring consequent to subarachnoid hemorrhage. A case of terson syndrome resulting with subarachnoid hemorrhage and right vitreous hemorrhage resulting from a left pericallosal artery aneurysm. Pdf this prospective trial was designed to evaluate the incidence of terson syndrome in patients suffering from subarachnoid hemorrhage, intracerebral. Intraocular hemorrhage can be a subretinal, retinal, preretinal, subhyaloidal, or intravitreal hemorrhage. Purpose terson syndrome may be overlooked in the acute setting and often requires ophthalmologic intervention to prevent longterm visual loss. Tersons syndrome refers to vitreous hemorrhage after intracranial hemorrhage, often from rupture of an aneurysm. Blood may track along the subarachnoid space of the optic nerve sheath and enter the vitreous cavity through the optic nervehead. This study presents a rare case of terson syndrome with no cerebral hemorrhage secondary to tbi. The occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage.
Terson syndrome was originally defined as a vitreous hemorrhage arising from an aneurysmal subarachnoid hemorrhage sah. Suspected visual loss following sah should prompt a search for tersons syndrome by funduscopy, as its presence is an adverse prognostic factor. Terson syndrome ts is the presence of any intraocular hemorrhage, including vitreous, subhyaloid, intraretinal, or subretinal bleeding. External photograph of right eye demonstrates blunted red reflex secondary to vitreous hemorrhage figure 2. Tersons syndrome following epidural saline injection. We present a case of vision loss immediately following an ebp. Subarachnoid haemorrhage sah associated with vitreous haemorrhage was first described by french ophthalmologist albert terson in 1900. One cause is intracranial hemorrhage from a cerebral aneurysm. Pars plana vitrectomy for tersons syndromevisual outcome. Tersons syndrome is a condition in which intracranial bleeding is associated with hemorrhage inside the eye.
Terson syndrome is defined as intraocular hemorrhage associated with intracranial bleeding. Three prospective studies satisfied the inclusion criteria. Tersons syndrome as a prognostic factor for mortality of. Case report a 49yearold woman with idiopathic intracranial hypertension received an ebp for postdural puncture headache at an outside facility without fluoroscopic guidance and in the seated position. A case of terson syndrome in a 7monthold infant othon j. Tersons syndrome is characterised by vitreous haemorrhage accompanying subarachnoid or any other form of intracranial haemorrhage.
Although early studies attempted to link this syndrome with aneurysms of the anterior communicating artery, statistical analysis has not correlated it with a specific aneurysmal location. View the article pdf and any associated supplements and figures for a period of 48 hours. A serious ophthalmological complication of an endoscopic third ventriculostomy that created an iatrogenic terson syndrome is described. Although litten reported vitreous haemorrhage in association with subarachnoid haemorrhage in 1881, it was terson who described the syndrome in 1900. Terson syndrome has been described most commonly in subarachnoid hemorrhages due to ruptured cerebral aneurysms. Vision restoration and lowered mortality can be achieved by early diagnosis and prognosis monitoring of intraocular bleeding through ophthalmological examinations and veps in patients with subarachnoid hemorrhage presenting cognitive impairment or visual field problems. Terson syndrome definition of terson syndrome by medical. The trip database provides clinical publications about evidence. A retrospective study of four patients with tersons syndrome from royal prince alfred hospital, sydney, was carried out. Ab background tersons syndrome is intraocular hemorrhage ioh subsequent to subarachnoid hemorrhage sah.
Tersons syndrome is a frequent cause of visual loss following subarachnoid haemorrhage sah. The source of vitreous blood has never been established conclusively. Alternatively, the sudden spike in intracranial pressure may burst retinal vessels. Pars plana vitrectomy was performed in one eye twelve weeks, and in four eyes six months after the acute event. Terson syndrome with persistent vitreous hemorrhage following. A 36yearold woman presented with acute severe headache and generalized tonicclonic seizures. Case report the patient, a 33yearold male miner, was hit in the right occipital region by a boulder while mining, three hours prior to admission to a local clinic. An abrupt increase in intracranial pressure icp is typically responsible for this type of intraocular hemorrhage. The incidence of terson syndrome in patients with tsah was higher in those age under 40 than in those aged 40 or over. Download fulltext pdf download fulltext pdf download fulltext pdf download fulltext pdf download fulltext pdf download fulltext pdf terson syndrome and leukemia. Domeshaped posterior pole haemorrhages have been described in terson syndrome ts. External photograph of left eye demonstrates normal red reflex figure 3.
Terson syndrome or tersons syndrome is the occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage. Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. Haemorrhage in tersons syndrome may be contained between the internal limiting membrane and retina or extend into. There are no case reports on atypical arn combined with tersons syndrome. Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Bedside optical coherence tomography for tersons syndrome. Strict guidelines for treatment have not been established by clinical studies. This syndrome can occur in the event of intracranial hemorrhage or. Bedside optical coherence tomography for tersons syndrome screening in acute subarachnoid hemorrhage. In the only published prospective case series of nonabuse instances of intracranial hemorrhage in children, 63 2% had intraocular hemorrhages. Pdf terson syndrome in subarachnoid hemorrhage, intracerebral. Acute retinal necrosis arn has characterized by panuveitis, vitritis, severe vasoocclusive vasculitis, and diffuse necrotizing retinitis. Background and objectives lumbar epidural blood patch ebp is a commonly used procedure to treat postdural puncture headache. Tersons syndrome, subinner limiting membrane hemorrhage photographer shin jiyoung, eulji university, seoul imaging device fundus camera topcon trc 50 ex description fundus photograph of a 56yearold woman with a subilm hemorrhage.
Assessment of visual acuity and physical disability pre and postvit rectomy using the snellen chart and the barthel index, respectively, was performed. Tersons syndrome refers to the occurrence of vitreous hemorrhage with subarachnoid hemorrhage sah, usually due to a ruptured cerebral aneurysm. Atypical acute retinal necrosis accompanied by tersons. Unilateral vitreous haemorrhage secondary to caudal. Terson syndrome in aneurysmal subarachnoid hemorrhage. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. These frequently arise after rupture of an intracranial aneurysm, or dilated vessel in the brain.
This syndrome can occur in the event of intracranial. Terson syndrome vitreous hemorrhage in patients surviving subarachnoid hemorrhage appears to be more common than previously thought, underscoring the need for routine funduscopic screening. 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. Garfinkle am, danys ir, nicolle da, colohan art, brem s. Introduction intraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as tersons syndrome and is an underestimated but common pathology. Retinal hemorrhages, especially those occurring in multiple layers, are frequently noted in infants in the setting of suspected abusive head trauma. Pointofcare handheld ophthalmic ultrasound in the diagnosis and evaluation of raised intracranial pressure and.
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