Author: Youness Hidan (Morocco)
Co-authors: Moctar Issiaka, Hamza Jamaledine, Adil Mchachi, Leila Benhmidoune, Rayad Rachid, Mohamed Elbelhadji
The association of subarachnoid hemorrhage and intracranial hemorrhage was described by a French ophthalmologist Albert Terson in 1900, and currently this syndrome now corresponds to the association of any type of intracranial hemorrhage accompanied by intraocular hemorrhage. We report the case of a 45-year-old patient, injured in a road accident in whom the diagnosis of Terson syndrome was retained and who was followed in our structure.
the patient was injured in a road accident with cranial trauma at the right parieto-occipital point of impact. The cerebral tododensitometry performed in the emergency room revealed the presence of a bifrontal extradural hematoma and subarachnoid hemorrhage.
The patient showed 4 hours later, a brutal visual loss, without pain or redness in his right eye. The ophthalmologic examination found a visual acuity at 1/10, a normal anterior segment and at the fundus a stage 3 intra-vitreous hemorrhage. The ocular ultrasound did not show any retinal or choroidal detachment. The patient was initially treated neurologically with good postoperative consequences. On the ophthalmological level, the conduct consisted of strict rest, good rehydration, with weekly checks. The evolution was marked by the spontaneous resorption of the bleeding after one month with recovery of visual acuity to 8/10, without correction.
The exact pathophysiology of Terson's syndrome is not yet known but several hypotheses are discussed, including that suggesting a rupture of the peripapillary and retinal capillaries secondary to a sudden increase in intravascular pressure following a sudden intracranial hyperpressure. The treatment can be conservative, on the basis of periodic monitoring, a pars plana vitrectomy from the outset is considered in certain indications, particularly in cases of macular hemorrhage, binocular involvement, or in children at risk of amblyopia.
Terson's syndrome is a rare complication of cerebral-meningeal hemorrhages, whether post-aneurysm rupture or post-head trauma. A rapid ophthalmologic evaluation is necessary in the context of cerebral hemorrhage. Their prognosis remains better in the absence of other complications and in the event of adequate early management.