Terson’s syndrome: A report of two cases

Karadžić, Jelena; Kovačević, Igor; Stefanovic, Ivan; Risimic, Dijana

doi:10.2298/sarh1510595k

Cited by 4 publications

(11 citation statements)

References 10 publications

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“…For that reason it has been only rarely commented on in neurosurgical discussions of SAH. 57,58 The most meaningful way to detect RD in patients with SAH is to perform serial bedside eye examinations in the neurointensive care unit. We presented a preliminary experimental study to understand the mechanism of RD after SAH.…”

Section: Resultsmentioning

confidence: 99%

Describing a New Mechanism of Retinal Detachment Secondary to Ophthalmic Artery Vasospasm Following Subarachnoid Hemorrhage: An Experimental Study

Fındık

Kanat

Aydın

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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Background The pterygopalatine ganglion (PPG) and ophthalmic arteries (OpAs) have important roles in ocular autoregulation and retinal and visual functions. The relationship between PPG neuron density, OpA vasospasm, and retinal detachment in subarachnoid hemorrhage (SAH) has never been studied. Methods This study was conducted on 25 rabbits. Five animals were in the control group (GI; n = 5), five in the sham group (GII; n = 5), and 15 in the study group (GIII; n = 15). After injection of 1 cc serum saline into the cisterna magna in the sham group, and autologous blood in the SAH group, the animals were followed for 3 weeks. All animals underwent a retinal examination five times a week for 3 weeks before and after the experiment. After the experiment, the neuron density of PPGs of the facial nerves, vasospasm index (VSI) of OpAs, and total basal surface values of the detached retinal parts (DRPs) were calculated. Results In the funduscopic examination, intravitreous hemorrhage ( Terson's syndrome) was detected in four animals in the SAH group. In the control groups, neuron density was 12,000 ± 1,240/mm3, VSI = 0.345 ± 0.076, and DRP = 0 to 1.5 mm2. Mean neuron density was 9,450 ± 940/mm3, VSI = 1.645 ± 0.940, and DRP = 6.23 ± 1.61 mm2 in the sham group (p < 0.05). Neuron density was 6,890 ± 932/mm3, VSI = 2.92 ± 0.97, and DRP = 9.43 ± 2.54 mm2 in SAH group. Conclusion Mean neuron density, VSI of OpAs, and DRP values differed statistically significant between the SAH group and other groups (p < 0.005). There is an inverse relationship between PPG neurons and DRP. However, a direct relationship was observed between the mean VSI and DRP values.

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Section: Resultsmentioning

confidence: 99%

Describing a New Mechanism of Retinal Detachment Secondary to Ophthalmic Artery Vasospasm Following Subarachnoid Hemorrhage: An Experimental Study

Fındık

Kanat

Aydın

et al. 2019

J Neurol Surg A Cent Eur Neurosurg

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“…El síndrome de Terson consiste en hemorragias en el polo posterior del ojo como resultado de un trauma cerebral, un hematoma epidural/subdural o una hemorragia subaracnoidea, estas últimas con se presentan con mayor incidencia, pero con frecuencia no se identifican, probablemente porque estos pacientes se encuentran en situaciones que ponen en riesgo su vida y la evaluación oftalmológica inmediata no forma parte del protocolo de manejo en trauma, además del desconocimiento de esta condición por parte de las especialidades médicas que están involucradas en el tratamiento inicial de estos pacientes 2 . Por otra parte, la presencia asociada de glaucoma de células fantasmas secundario a hemorragia vítrea persistente en un caso de síndrome de Terson es un evento muy raro, con solo otros dos casos descritos en la literatura [5][6] . Gnanaraj y coautores reportaron un caso de glaucoma de células fantasma asociado a síndrome de Terson en una paciente de 46 años, dentro de su serie de 25 ojos.…”

Section: Discussionunclassified

“…Se manejó médicamente. A los 6 meses la presión intraocular estaba normal, se había reabsorbido la hemorragia vítrea y la agudeza visual fue de 20/33 5 .…”

Section: Discussionunclassified

“…Se desconoce la fisiopatología del síndrome de Terson, pero se cree que la elevación súbita de la presión intracraneal fuerza la sangre o el fluido cerebral hacia los espacios subaracnoideos de los nervios ópticos, ahí, la vena central de la retina y las anastomosis coroideas colapsan por la elevada presión a la que son sometidas, lo que causa la ruptura de vénulas y capilares y eventualmente, genera la aparición de la hemorragia retiniana en cualquiera de los plexos retinianos en cualquiera de sus formas 11 . Se ha reportado que después de realizar una vitrectomía vía pars plana por una hemorragia vítrea secundaria a un síndrome Terson, se evidencia fuga de fluoresceína en el nervio óptico, determinándose que las estructuras correspondientes a esta demarcación son la membrana limitante interna, el borde de tejido de Elschnig y el borde de tejido de Jacoby sugiriendo que la ruptura de estos capilares genera una hidrodisección de la capa limitante interna y la subsecuente hemorragia vítrea [4][5][6][7][8][9][10][11][12] .…”

Section: Discussionunclassified

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Glaucoma de células fantasmas secundario a Síndrome de Terson en un ojo fáquico

Rivas

2021

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Paciente masculino con antecedente de trauma craneoencefálico severo recibido en la unidad de emergencia con una puntuación en la escala de Glasgow de 3 puntos; se describió en la tomografía computarizada un hematoma frontal epidural y una hemorragia subdural aguda; fue intervenido quirúrgicamente por neurocirugía en la Unidad de Emergencias y posteriormente fue llevado a la unidad de cuidados intensivos donde durante la recuperación (2 meses) refirió disminución de la agudeza visual en ojo izquierdo; fue evaluado en el servicio de Oftalmología donde la agudeza visual del ojo derecho fue de 20/40 y en ojo izquierdo no percibe la luz, en la evaluación oftalmológica se evidencia la presión intraocular en ojo izquierdo de 44mmHg, abundante celularidad en cámara anterior y a la evaluación ultrasonografía de cámara vítrea se describe una imagen que se correlaciona con una aparente hemorragia vítrea. Se diagnostica con Glaucoma de células fantasmas y síndrome de Terson; se inicia tratamiento médico con antiglaucomatoso para el glaucoma de células fantasmas y expectante para el síndrome de Terson, a la semana debido a la pobre respuesta se realizó trabeculectomia y vitrectomía vía Pars plana, posterior al tratamiento oftalmológico, se describió una visión de ojo izquierdo de 20/200.

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“…Terson syndrome (TS) is defined as an intraocular hemorrhage associated with intracranial hemorrhage and was first described by the French ophthalmologist Albert Terson in 1900 [1] . The incidence of TS is variably described in the literature and is in the order of 10 to 50% after subarachnoid hemorrhage [2] , [3] . The exact pathophysiology of Terson syndrome is not yet well known, but several hypotheses are discussed.…”

Section: Introductionmentioning

confidence: 99%

Terson syndrome: Two case reports

Issiaka

Mchachi

Rachid

et al. 2022

International Journal of Surgery Case Reports

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Purpose Vitreous or retinal hemorrhage occurring in association with subarachnoid hemorrhage (SAH) is known as Terson syndrome (TS). Its incidence is of the order of 10–50% after subarachnoid hemorrhage. We report two cases of TS with different clinical presentations, different managements, and a good final prognosis, which were managed at the Ibn Rochd hospital in Casablanca. Observations We report two cases of TS. The first one occurred in a 55-year-old hypertensive man following a ruptured aneurysm of the internal carotid artery, revealed by a decrease in visual acuity concomitant with the neurological symptomatology. The evolution was favorable after specialized neurological management and spontaneous resorption of the intravitreal hemorrhage was obtained 3 months after the acute episode with good visual recovery. The second case was that of a 45-year-old man who presented with an intravitreal hemorrhage of the right eye, 24 h after severe head trauma responsible for a bifrontal extradural hematoma. The B-mode ocular ultrasound discovery of a retinal detachment with persistent hemorrhage led to the indication of a pars plana vitrectomy with retinal tamponade, which allowed visual rehabilitation without recurrence after 1 year. Conclusions Ophthalmologic evaluation by specialized examination and radiology (ocular ultrasound, OCT) is necessary for all patients with TS because early diagnosis and treatment can prevent visual loss and associated complications. Treatment of TS can be conservative and based on periodic monitoring. A pars plana vitrectomy is considered in some cases.

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Terson’s syndrome: A report of two cases

Cited by 4 publications

References 10 publications

Describing a New Mechanism of Retinal Detachment Secondary to Ophthalmic Artery Vasospasm Following Subarachnoid Hemorrhage: An Experimental Study

Describing a New Mechanism of Retinal Detachment Secondary to Ophthalmic Artery Vasospasm Following Subarachnoid Hemorrhage: An Experimental Study

Glaucoma de células fantasmas secundario a Síndrome de Terson en un ojo fáquico

Terson syndrome: Two case reports

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