Ophthalmic surgery, lasers and imaging retina mayjune. Tersons syndrome refers to the occurrence of vitreous hemorrhage with subarachnoid hemorrhage sah, usually due to a ruptured cerebral aneurysm. The mean time interval between intracranial haemorrhage and vitrectomy was nine months range 7. Intracranial pressure was measured by lumbar puncture and subsequently by intracranial pressure bolt monitoring. Terson syndrome was originally used to describe a vitreous hemorrhage arising from aneurysmal subrarachnoid hemorrhage. It has been hypothesized that the bleeding results when a sudden rise in intracranial pressure causes rupture of retinal and peripapillary vessels. Castren subarachnoid hemorrhage is a disease where patients usually have been fallen ill with sudden signs of severe headache, nausea or loss of consciousness. This is not a forum for general discussion of the articles subject put new text under old text. The differential diagnoses include birth trauma, terson syndrome, disseminated intravascular coagulation, galactosemia,2 and retinopathy of prematurity. Incidence, morbidity, and mortality of terson syndrome in. Radiology teaching files university of rochester medical. An early diagnosis can be achieved with routine bedside ophthalmoscopy. Evidence for the existence of a communication between the eye and the brain. 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 with persistent vitreous hemorrhage following. Terson syndrome is the presence of vitreous or subinternal limiting membrane ilm hemorrhage after acute intracranial hemorrhage. Computed tomography scan showed evidence of brain contusion. Terson syndrome now encompasses any intraocular hemorrhage associated with intracranial hemorrhage and elevated intracranial pressures. Practical incidence and risk factors of tersons syndrome. The visual outcomes of vitrectomy in a series of five eyes of three patients with vitreous haemorrhage due to terson syndrome were retrospectively evaluated. We present the case of a 7monthold female infant who was found crying and limp. Only four of the 10 patients with terson syndrome survived. In seven cases of terson s syndrome, an elevated, domeshaped, membrane was detected in the posterior pole by ophthalmoscopy, echography, or during pars plana vitrectomy.
Reduced vision in such fresh case is due to hemorrhage itself, blocking macula other photo receptors in the long run macular cellophane retinopathy which causes profound visual loss. Subarachnoid haemorrhage presenting as sudden visual loss terson s syndrome. Although the vitreous blood can clear spontaneously, it can take a year or more, hence an operation called a vitrectomy is often. Terson syndrome is subarachnoid hemorrhage sah with sub retinal hemorrhage flowing through channel. However, the most predominant hypothesis involves rapidly increased intracranial pressure that leads to effusion of csf into the optic nerve sheath. Often requires ophthalmologic intervention to prevent vision loss. Retinal or vitreous hemorrhage due to abrupt rise in intracranial hemorrhage resulting in venous hypertension and intraocular hemorrhage.
A preoperative ct scan demonstrated subarachnoid hemorrhage, bilateral optic nerve sheath hemorrhage, and bilateral intraocular hemorrhage. Aug 25, 2015 terson syndrome can be an important marker to assess patients outcome. Subilm haemorrhages have been associated with various different causes, the most common being valsalva retinopathy 4 and tersons syndrome. Fifteen eyes of 1 1 male patients four bilateral with the diagnosis of terson syndrome underwent vitreous surgery. Tersons syndrome after endoscopic colloid cyst removal. The differential diagnoses include birth trauma, terson syndrome, disseminated intravascular coagulation, galactosemia, 2 and retinopathy of prematurity. Maternal antiphospholipid antibodies and vitreous hemorrhages. In our case, the treatment resulted in recovery of vision and improved activities of daily. This case shows an extensive subarachnoid hemorrhage with blood in the posterior globe.
Radiology teaching files university of rochester medical center. The occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage. The features, severity, and timing of the pathology are suggestive of terson syndrome that has occurred during the peripartum period. Drainage of premacular subhyaloid hemorrhage into the vitreous with an nd. The odds of allcause mortality with terson syndrome vs. We report a fatal case of terson s syndrome in a pregnant lady. Retinal foldsperimacular folds occur in 20% of patients with terson syndrome, retinal detachment occurs in 9%. Terson s syndrome is a condition in which intracranial bleeding is associated with hemorrhage inside the eye. Intrathecal anesthesia after retrobulbar block, with terson like syndrome.
I, zstardust grants anyone the right to use this work for any purpose, without any conditions, unless such conditions are required by law. We report on five cases in which the subilm location of the premacular haemorrhage was confirmed during pars. Most cases of tersons syndrome involve patients who have had subarachnoid hemorrhages. In addition, there is a high attenuation area within the left posterior globe likely reflecting hemorrhage, terson syndrome. She was transported to a hospital where a possible subarachnoid hemorrhage was diagnosed radiologically. Terson syndrome or tersons syndrome is the occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage. Abstracttersons syndrome is a condition of vitreous haemorrhage occurring in association with subarachnoid haemorrhage sah. Terson syndrome caused by intraventricular hemorrhage. The trip database provides clinical publications about evidence.
Dec 27, 2017 terson syndrome ts was first described by the french ophthalmologist, albert terson in 1900, as vitreous or subhyaloid hemorrhage secondary to intracerebral hemorrhage and the main cause of the syndrome is sah from a ruptured intracranial aneurysm. The pathogenesis of tersons syndrome has been controversial, but there are 2. Aug 20, 2019 ley 28716 pdf ley pdf download as pdf file. In the case of terson syndrome, bleeding occurs in the vitreous body as well as in the retina due to a buildup of pressure in the retinal veins. This is the talk page for discussing improvements to the terson syndrome article. Vitreous blood may cause erms by inducing glial proliferation and disruption of the ilm. The optic nerves appear thickened bilaterally likely secondary to papilledema. Ophthalmoscopy and bscan ocular ultrasound disclosed vitreous hemorrhages, features consistent with terson syndrome. Tersons syndrome encompasses any intraocular haemorrhage associated with intracranial subarachnoidal haemorrhage and increased intracranial pressures. Intraocular hemorrhage associated with subarachnoid hemorrhage terson syndrome case discussion. These cases highlight the need for early ophthalmologic evaluation in infants with significant.
Performing vitrectomy with bss as a tamponade in patients with terson syndrome significantly improves visual acuity, so early diagnosis and surgical treatment are crucial. How science will shape human destiny and our daily lives by the year is a book by theoretical. In seven cases of tersons syndrome, an elevated, domeshaped, membrane was detected in the posterior pole by ophthalmoscopy, echography, or during pars plana vitrectomy. A patient with a subarachnoid hemorrhage after endovascular. Following her last injection, she complained of a moderately severe protracted headache and had several attempts at placement of an epidural blood patch without success. The combination of these features is known as terson syndrome subarachnoid hemorrhage has multiple grading systems, both clinically and radiologically based. Terson syndrome from a significant cerebral infarct. The surgical treatment included vitrectomy with pvr removal, ilm peeling and silicone oil as a tamponade. The less severe haemorrhage in the left vitreous cleared in. It has been reported that about 50% of vitreous hemorrhages do not resolve after 19 months. Terson syndrome originally was defined by the occurrence of vitreous hemorrhage in association with subarachnoid hemorrhage. Frequently, cardiac arrhythmias and the complex symptom, terson syndrome, are noted. In some countries this may not be legally possible. Terson syndrome with bilateral optic nerve sheath hemorrhage.
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. This article is from clinical ophthalmology auckland, n. While being transported to a triage center by helicopter, the patients condition deteriorated, as flexor. Terson syndrome is the occurrence of intraocular hemorrhage secondary to intracranial hemorrhage.
Effectiveness of vitrectomy in terson syndrome case series. If the address matches an existing account you will receive an email with instructions to retrieve your username. We report a fatal case of tersons syndrome in a pregnant lady. Most cases of terson s syndrome involve patients who have had subarachnoid hemorrhages. Terson s syndrome is an underestimated complication of subarachnoid haemorrhage.
Complications included a macular hole in 1 eye and a retinal detachment from a retinal break in a myopic patient. Tersons syndrome intraocular hemorrhage associated with subarachnoid hemorrhage often seen in the acute traumatic setting. Intraocular hemorrhage can be a subretinal, retinal, preretinal, subhyaloidal, or intravitreal hemorrhage. Terson syndrome originally was defined by the occurrence of. Tersons syndrome is a condition in which intracranial bleeding is associated with hemorrhage inside the eye. Terson syndrome ts was first described by the french ophthalmologist, albert terson in 1900, as vitreous or subhyaloid hemorrhage secondary to intracerebral hemorrhage and the main cause of the syndrome is sah from a ruptured intracranial aneurysm. A man in his 50s with a medical history of hypertension and methamphetamine abuse presented to an outside hospital with a severe headache and was diagnosed with a highgrade subarachnoid hemorrhage sah hunt and hess grade 3, fisher grade 4 complicated by acute hydrocephalus. Vitreous hemorrhage in the newborn, first described by schleich 1 in 1890, is a rare occurrence. Neonatal intracranialintraocular hemorrhage terson.
Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. This work has been released into the public domain by its author, i, zstardust. Vitreous hemorrhage of the eye can also occur in association with intracranial hemorrhage and elevated intracranial pressure icp. Retinal or vitreous hemorrhage due to abrupt rise in. Epiretinal membrane is the most common sequelae of terson syndrome, with an incidence of 1578%. Terson s syndrome requires ophthalmological followup and may require vitrectomy. Terson syndrome from a significant cerebral infarct occurring. The highest incidence of tersons syndrome from aneurysms in the internal carotid territory might be associated with the highest increase of intracranial pressure among the anterior circulation aneurysms, as discussed in the study by wang et al. Terson syndrome in aneurysmal subarachnoid hemorrhage.
Ideal sources for wikipedia s health content are defined in the guideline wikipedia. Subarachnoid hemorrhage sah symptoms, diagnosis and treatment. She presented with an episode of seizure and complained of blurring of vision in the right eye after the seizure. Direct correlation between severity and expansion of cerebral hemorrhage is detected.
The system is intended to provide practice to physicians, fellows and residents in the interpreptation of radiological images from a variety of different cases. Hemorrhage from retinal or ciliary vessels due to trauma, arteriovenous malformation avm, or aneurysm terson syndrome, usually from ruptured anterior communicating artery acomma aneurysm. Management of retinal detachment with severe proliferative. This photo shows a patient with a large subilm hemorrhage. The neurological diagnosis included craniocerebral trauma and cerebral aneurysm rupture. This study evaluates the feasibility and potential role of bedside optical coherence tomography oct in tersons syndrome ts in patients with acute sah asah and its potential role in blindness prevention. Terson syndrome is defined as vitreous or retinal hemorrhage in the presence of intracranial hemorrhage. Strict guidelines for treatment have not been established by clinical studies. The etiology of vitreous hemorrhage is still unclear. Based on this study, approximately onefifth of patients admitted to the hospital with a spontaneous sah could have terson syndrome. Terson syndrome can be an important marker to assess patients outcome. Tersons syndrome has been defined as vitreous or retinal hemorrhage in the presence of intracranial hemorrhage, occurring in 12. Effectiveness of vitrectomy in terson syndrome case. 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.
Endovascular treatment by coiling to prevent rebleeding was performed previously. Intrathecal anesthesia after retrobulbar block, with. Jan 01, 2011 terson syndrome is the occurrence of intraocular hemorrhage secondary to intracranial hemorrhage. Bedside optical coherence tomography for tersons syndrome. Nonaccidental trauma, such as shaken baby syndrome, is a diagnosis of exclusion, which must be considered in all cases. Bilateral terson syndrome before treatment top images and. Neonatal intracranialintraocular hemorrhage terson syndrome.
One of the opening lines of suda 51s whackedout, blood stained. These frequently arise after rupture of an intracranial aneurysm, or dilated vessel in the brain. A case of terson syndrome in a 7monthold infant othon j. Subarachnoid hemorrhage sah symptoms, diagnosis and. Subarachnoid haemorrhage presenting as sudden visual loss moynihan, gerard. Tersons syndrome, subinner limiting membrane hemorrhage photographer shin jiyoung, eulji university, seoul imaging device optical coherence tomography system heidelberg spectralis description oct image of a 56yearold woman with a subilm hemorrhage. Usually the intraocular bleeding occurs in both eyes. Magnetic resonance imaging mri was used to diagnose the chiari i malformation. We present a case of aneurysmal subarachnoid hemorrhage accompanied by a dense vitreous hemorrhage and subsequent retinal detachment with strong proliferative retinopathy pvr in a young woman. Fahmy a 66yearold man developed bilateral vitreous haemorrhage in connection with a ruptured leftsided carotid aneurysm.
Proust 0 0 department of neurosurgery, university hospital of strasbourg, avenue moliere, 67000 strasbourg, france we have read with interest the letter to the editor. Terson syndrome caused by ventricular hemorrhage associated. The articles prior to january 20 are part of the back file collection and are not available with a current paid subscription. Longterm results after drainage of premacular subhyaloid. Terson syndrome is defined as intraocular hemorrhage associated with. Vitreous hemorrhage in the newborn, first described by schleich1 in 1890, is a rare occurrence. Terson syndrome or terson s syndrome is the occurrence of a vitreous hemorrhage of the human eye in association with subarachnoid hemorrhage. Tersons syndrome condition keywords tersons syndrome description 39 year female with a long history of chronic back pain treated by a sequence of epidural injections.