Pseudotumor cerebri syndrome causing a terson like syndrome

Abstract

Purpose Terson syndrome presents with retinal and vitreous hemorrhages in patients with a subarachnoid hemorrhage or after acutely elevated intracranial pressure. The source of this hemorrhage has been debated and may originate either from direct extension of intracranial hemorrhage or more likely from the peripapillary retinal vessels. Observations A 39-year-old woman presenting with nausea, vomiting, floaters and papilledema with normal neuroimaging was diagnosed ultimately with pseudotumor cerebri syndrome. She had a right vitreous hemorrhage and bilateral subretinal and intraretinal hemorrhages which were consistent with Terson like syndrome. Her symptoms resolved with acetazolamide over one month and the retinal and vitreous hemorrhages significantly improved over two months. Conclusions and importance This case with initial presentation of pseudotumor cerebri syndrome causing a Terson like syndrome may help elucidate the mechanism behind the etiology of these hemorrhages from leaking peripapillary vessels.

Three-Layered Optic Disc Hemorrhages in Idiopathic Intracranial Hypertension

“…Multilayered ODH in IIH are rare and were not found in patients enrolled in the IIH Treatment Trial. Subretinal hemorrhages [ 3 ] and preretinal hemorrhages [ 4 ] have previously been identified in IIH patients in isolation, and we identified one case with a combination of preretinal and intraretinal hemorrhages in one eye [ 5 ]. The eye that had multilayered hemorrhages had only mild vision loss at presentation with a mean deviation of −4.00 dB and an enlarged blind spot on Humphrey visual field testing and had a good visual outcome.…”

“…Because most of the vessels on the optic disc are venous in nature, their thin walls are prone to rupture as optic nerve fibers swell and result in venous stasis. As the papilledema increases in severity, the central retinal vein may be obstructed, increasing the likelihood of more severe hemorrhaging [ 5 ]. The acuity of the papilledema may also be an important factor in producing hemorrhaging in addition to the severity of papilledema.…”

Papilloedema with retinal haemorrhages in idiopathic intracranial hypertension

“…There are few case reports of retinal vascular changes in association with IIH, some due to central retinal vein occlusion, 1 2 and others due to pre-retinal and vitreous haemorrhage. 3 It has been speculated that an acute rise in intracranial pressure compresses the central retinal vein in the region of the optic nerve head. 4 This mechanism would explain the observed venous tortuosity and distribution of haemorrhages along the vascular arcades.…”

“…Further investigations did not reveal an underlying systemic disorder. There are few case reports of retinal vascular changes in association with IIH, some due to central retinal vein occlusion,1 2 and others due to pre-retinal and vitreous haemorrhage 3. It has been speculated that an acute rise in intracranial pressure compresses the central retinal vein in the region of the optic nerve head 4.…”

Vitreous Hemorrhage as the Presenting Sign of Idiopathic Intracranial Hypertension

“…The extent and presence of hemorrhage has been positively correlated with the degree of papilledema; however, it did not confer any prognostic value after controlling for the severity of papilledema in a previous study [ 1 ]. Rarely, severe hemorrhaging in idiopathic intracranial hypertension (IIH) may appear similar to Terson's syndrome seen in patients with subarachnoid hemorrhage [ 2 ]. Here, we describe a rare case of vitreous hemorrhage, which was the presenting sign of IIH in an otherwise asymptomatic individual.…”