Terson Syndrome With Cranial Nerve 3 Palsy Due to Subarachnoid Hemorrhage from Arteriovenous Malformation and Aneurysmal Rupture

A case of Terson syndrome due to AVM and posteral cerebral aneurysm. The patient developed a left CN3 palsy due to hematoma involving the left midbrain. Figure 1 : External photograph of right eye demonstrates blunted red reflex secondary to vitreous hemorrhage Figure 2 : External photograph of left eye demonstrates normal red reflex Figure 3 : Fundus photo of the left eye demonstrates diffuse preretinal and intraretinal hemorrhages as well as blurring of the optic disc margins Figure 4 : Fundus photograph of the right eye demonstrates an obscured view of the retina due to vitreous hemorrhage Figure 5 : External photograph demonstrates an abducted and depressed left eye with ptosis due to a left cranial nerve 3 palsy. The pupils are pharmacologically dilated. Figure 6 : Head CT without contrast demonstrates intraventricular blood and subarachnoid hemorrage. Figure 7 : Head CT without contrast demonstrates a hematoma extending into the left midbrain (explaining the left third nerve palsy). Figure 8 : CT-angiogram demonstrates left parieto-occipital arteriovenous malformation. Figure 9 : CTA demonstrates an elongated saccular aneurysm arising posteriorly and superiorly from the left P1 segment of the posterior cerebral artery