Practical Incidence and Risk Factors of Terson's Syndrome: A Retrospective Analysis in 322 Consecutive Patients with Aneurysmal Subarachnoid Hemorrhage

Abstract

ObjectiveTerson's syndrome, a complication of visual function, has occasionally been reported in patients with aneurysmal subarachnoid hemorrhage (SAH), however the factors responsible for Terson's syndrome in aneurysmal SAH patients have not yet been fully clarified. In this study, we report on potential risk factors for prediction and diagnosis of Terson's syndrome in the earlier stage of the disease course in patients with aneurysmal SAH.Materials and MethodsThe authors retrospectively analyzed the data of 322 consecutive patients who suffered from aneurysmal SAH in a single institution between Jan. 2007 and Dec. 2013. Medical records including demographics, neurologic examination, and radiologic images were collected to clarify the risk factors of Terson's syndrome. Patients with visual problem were consulted to the Department of Ophthalmology.ResultsAmong 332 patients with aneurysmal SAH, 34 patients were diagnosed as Terson's syndrome. Four individual factors, including World Federation of Neurosurgical Societies (WFNS) grade at admission, aneurysm size, method of operation, and Glasgow outcome scale showed statistically significant association with occurrence of Terson's syndrome. Of these, WFNS grade at admission, aneurysm size, and method of operation showed strong association with Terson's syndrome in multivariate analysis. Terson's syndrome accompanied by papilledema due to increased intracranial pressure led to permanent visual complication.ConclusionIn patients with aneurysmal SAH, the patients' WFNS grade at admission, the size of the aneurysms, particularly the diameter of the aneurysm dome, and the method of operation might influence development of Terson's syndrome.

Incidence of Terson Syndrome in Treated Subarachnoid Hemorrhage in South Korea: a National Health Insurance Database Study

“…In one such retrospective report, Lee et al . reported that the incidence of Terson syndrome in a Korean hospital between 2007 and 2013 was 10.6% (34 of 332 patients with aneurysmal SAH) 8 , while Seif et al . reported that the incidence of Terson syndrome in a Canadian hospital from 2012 to 2013 was 21.7% (10 of 46 patients with spontaneous SAH) 3 .…”

“…Lee et al . reported that, in aneurysmal SAH, the treatment method differed between patients with Terson syndrome and those without the syndome; endovascular coil embolization was significantly correlated with Terson syndrome diagnosis 8 . They hypothesized that cerebrospinal fluid release during microsurgical aneurysmal clipping may prevent increases in intracranial pressure, and that this may influence the occurrence of intraocular hemorrhage.…”

“…Lee et al . reported that the mean age of patients with both SAH and Terson syndrome was 54.3 years, while that of patients with SAH and without Terson syndrome was 56.0 years 8 . However, no studies have described the age distribution of patients with Terson syndrome.…”

“…In several previous single-institution studies, the incidence of Terson syndrome among patients with SAH was 2.5%–40.5% 2,3,6,7 . A single-hospital study from South Korea reported that the incidence of Terson syndrome was 10.6% 8 . Only one systematic review has focused on Terson syndrome incidence 9 .…”

Terson Syndrome in Patients with Aneurysmal Subarachnoid Hemorrhage: A 10-Year Single-Center Experience

“…Terson syndrome (TS), first described by Moritz Litten in 1881 and named after the French ophthalmologist Albert Terson, is a relatively common complication after subarachnoid hemorrhage (SAH), with rates of 10.2-46% in the literature [1][2][3]. It refers to an intraocular hemorrhage, for example, into the subhyaloid or intraretinal layers of the retina, or a vitreous hemorrhage (VH) which represents 3-5% of cases in the literature [2,4,5].…”