Terson syndrome – the need for an earlier diagnosis

Author: Mário Lima Fontes (Portugal)

Co-authors: Mariana Leuzinger Dias, Jorge Meira, Elisa Camisa, Vítor Fernandes, Fernando Falcão Reis

Purpose

Terson syndrome is the occurrence of an intraocular hemorrhage in the vitreous, sub-hyaloid, or intraretinal/sub-internal limiting membrane as a consequence of intracranial hemorrhage. The main cause of the syndrome in adults is a subarachnoid hemorrhage (SAH) following the rupture of intracranial aneurysm. Its pathogenesis has not been fully understood. It is believed that the increase of intracranial pressure results in hemodynamic changes in ocular vessels. Although intraocular hemorrhages most frequently develop in the first hour after SAH, Terson syndrome can have a delayed onset, with reports of intraocular hemorrhage occurring up to 47 days after SAH. Here we report a case of a 56-year-old woman who was diagnosed with a bilateral vitreous hemorrhage almost 4 months after the rupture of a brain aneurysm.

Setting/Venue

This is a case report of a patient observed and managed in Centro Hospitalar Universitário de São João, in Porto, Portugal.

Methods

Analysis of a case report.

Results

A 56-year-old woman was diagnosed with a ruptured aneurysm of the right anterior cerebral artery with an associated SAH after a sudden loss of consciousness. She was submitted to an aneurysm clipping and later was transferred to a rehabilitation unit. Four months after the vascular event, she complained of sudden and painless right eye amaurosis, without any other symptoms or history of trauma. She was examined in our ER and showed reduced bilateral BCVA (right eye - hand movements; left eye - counting fingers). Right eye fundoscopy brought the suspicion of a vitreous hemorrhage, which was supported by ocular ultrasonography. Left eye examination also revealed small but central vitreous hemorrhage. No retinal defects were found. Two weeks later there was no improvement on the right eye and a pars plana vitrectomy was successfully performed. A complete reabsorption of the left eye hemorrhage was noticed during follow-up. 4 months after the procedure, right and left eye BCVA was 6/10 and 8/10, respectively. All the cerebral CT and MRI scans performed to evaluate the patient after the vascular event were reviewed and there were signs compatible with vitreous hemorrhage of the right eye at least 3 months before the visual complaints.

Conlusions

Terson syndrome is a cause of permanent impaired vision that can be foreseen and prevented with a prompt ophthalmologic evaluation and adequate treatment. It’s mandatory to fight the lack of awareness about this syndrome in order to guarantee earlier referring and to avoid irreversible damage.

Financial Disclosure

None.