Magnetic resonance imaging findings of Terson’s syndrome suggesting a possible vitreous hemorrhage mechanism

Abstract

The vitreous hemorrhage may be caused by a large amount of blood, originally formed by Terson's syndrome, entering the subarachnoid space around the optic nerve and from there infiltrating the intraocular space through the perivascular space around the central retinal vessels within the optic nerve.

The “Ocular Glymphatic System”: An Important Missing Piece in the Puzzle of Optic Disc Edema in Astronauts?

“…7 The pathway of subarachnoid hemorrhaged blood into the eye in Terson syndrome is still controversial. On the basis of magnetic resonance imaging findings of Terson syndrome and their review of the literature, Sakamoto et al 7 speculated that there may be a continuous network of paravascular channels that surround the central retinal vessels in the optic nerve and their branches in the retina, and that they may serve as drainage channels from the SAS around the optic nerve to beneath the internal limiting membrane. In the setting of microgravityinduced intracranial hypertension, raised ICP may similarly facilitate paravascular CSF influx into the eye.…”

Neurocritical Care Society 8th Annual Meeting

“…The high ICP associated with aneurismal rupture likely forces subarachnoid blood along the nerve-sheath complexes into the globes. An extrusion mechanism is also supported by a recent case report detailing a patient with SAH studied with magnetic resonance imaging [5]. Other mechanisms for hemorrhage may also exist, as Terson Syndrome can be seen in cases of intracranial hypertension without SAH.…”

“…There was no difference between groups in the prevalence of less frequent suctioning (78% vs. 50%, 0.53). Those patients who successfully extubated had fewer total ventilator days (median 3 [2][3][4][5] vs. 5 [3][4][5][6][7][8][9], p=0.03). No differences were seen in median ventilator days until first extubation attempt (2 [1][2][3][4] …”

“…In contrast, others have found that hypoalbuminemia is a relatively poor predictor of hospital mortality in medical and surgical patients (5). We tested the hypothesis that albumin is associated with morbidity and mortality in patients with ICH, a previously unstudied population.…”

“…Cases of recurrent PRES have been described in many conditions including end stage renal disease (ESRD) [2,3,4,5]. To our knowledge, this is the first case in which a patient on chronic hemodialysis (HD) developed PRES that led to recurrent cerebral edema and herniation with each subsequent HD treatment leading to death.…”