| OCR Text |
Show Journal of Neiiro- Oplitlwlmology 18( 2): 148- 149, 1998. © 1998 Lippincott- Raven Publishers, Philadelphia Terson's Syndrome in Subarachnoid Hemorrhage Agnes M. F. Wong, M. D., Wai- Ching Lam, M. D., and James A. Sharpe, M. D. A 43- year- old woman presented with acute onset of headache and vomiting. Subarachnoid hemorrhage ( SAH) was found on computed tomography scan. Cerebral angiography showed a dissecting aneurysm of the proximal right vertebral artery ( Fig. 1), which was occluded by a balloon technique. The patient's visual acuity was counting fingers OU. Retinal examination showed extensive bilateral retinal, Manuscript received November 20, 1997; accepted February 20, 1998. From the Department of Ophthalmology ( A. M. F. W., W- C. L.) and the Neuro- ophthalmology Unit ( J. A. S), Division of Neurology, the Toronto Hospital and the University of Toronto, Ontario, Canada. Address correspondence and reprint requests to Dr. James A. Sharpe, Division of Neurology, the Toronto Hospital, EC 5- 042, 399 Bathurst Street, Toronto, Ontario, Canada M5T 2S8. preretinal, and vitreous hemorrhage ( Fig. 2). Terson's syndrome was diagnosed, and observation was recommended. Three months later, the patient's visual acuity was 20/ 25 OU, and the hemorrhage resolved. Terson's syndrome refers to the occurrence of vitreous hemorrhage with ( SAH) ( 1). Intraocular hemorrhage- subretinal, intraretinal, and preretinal ( subhyaloid)- can also occur ( 2). Garfinkle et al. ( 2) observed vitreous hemorrhage in 3% to 5% of patients with SAH, whereas intraocular hemorrhage without vitreous hemorrhage occurred in 20% to 40% ( 2). The pathogenesis of Terson's syndrome is unclear. One widely accepted theory ( 3) suggested that the sudden increase in intracranial pressure in SAH is transmitted to the optic nerve sheath through the subarachnoid communication between the optic canal and intracranial cavity. The optic nerve sheath dilates and compresses both the central retinal vein and retinochoroidal anastomoses, thus reducing retinal venous drainage, with rupture of retinal vessels and hemorrhage into the vitreous. Patients with Terson's syndrome have a poor prognosis, with a mortality rate that is twice that of patients with SAH in whom there is no vitreous hemorrhage ( 2). For those who survive, visual recovery is usually good as the intraocular hemorrhage slowly resolves ( 4), and conservative management is recommended. Patients should be followed for ocular complications such as glaucoma and epiretinal membrane. Nonclearing vitreous hemorrhage may benefit from vitrectomy ( 5). REFERENCES 1. Terson A. Le syndrome de l'hematome du corps vitre et de l'hemorrhagie intracranienne spontanes. Ann Ocul 1926; 163: 666- 73. 2. Garfinkle AM, Danys IR, Nicolle DA, et al. Terson's syndrome: a reversible cause of blindness following subarachnoid hemorrhage. J Neurosurg 1992; 76: 766- 71. 3. Muller PJ, Deck JHN. Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension. J Neurosurg 1974; 41: 160- 6. 4. Toosi SH, Malton M. Terson's syndrome: significance of ocular findings. Ann Ophthalmol 1987; 19: 7- 12. 5. Clarkson JG, Flynn HW Jr, Daily MJ. Vitrectomy in Terson's syndrome. Am J Ophthalmol 1980; 90: 549- 52. 148 TERSON'S SYNDROME IN SUBARACHNOID HEMORRHAGE 149 FIG. 2. Fundus photographs taken at initial presentation showing extensive bilateral retinal, preretinal, and subhyaloid hemorrhages. Vitreous hemorrhage was seen interiorly ( not shown). A: Right eye. B: Left eye. J Neum- Ophtlialnml, Vol. 18, No. 2, 1998 |
