Terson’s syndrome in spontaneous spinal subarachnoid haemorrhage

Baker, Michelle L.; Hand, Peter J.; Tange, Damien

doi:10.1016/j.jocn.2006.09.011

Cited by 13 publications

(10 citation statements)

References 7 publications

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“…The term is only useful in infants if it provides some insight into the mechanism of RH. In adults with massive SAH (for example after a ruptured aneurysm or AV malformation), TS is observed in 27–40%, 54 and one proposed mechanism is the presumed sudden rise in intracranial pressure, but there are a number of other suggested mechanisms. In adults, macular schisis cavities have been reported.…”

Section: Alternative Explanations Proposed In Courtmentioning

confidence: 99%

Retinal haemorrhages in inflicted traumatic brain injury: the ophthalmologist in court

Vincent

Kelly

2010

Clinical Exper Ophthalmology

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Child abuse is a significant social and public health problem in many societies. One particular form of physical abuse is inflicted traumatic brain injury (ITBI) -the so-called 'Shaken Baby Syndrome'. One of the key features associated with ITBI is characteristic ocular findings -only observed on fundal examination. It is crucial not to miss the diagnosis of ITBI as there may be implications for the safety of the child. The ophthalmologist is one key contributor to the process required to make the diagnosis of ITBI accurately and on the basis of all the relevant evidence. This article discusses some medicolegal implications of examining a child with retinal haemorrhages in the context of suspected ITBI, with practical advice for the ophthalmologist to be as objective and prepared as possible. The scientific validity of some alternative explanations advanced in court is discussed, with a strong emphasis on the literature.

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Section: Alternative Explanations Proposed In Courtmentioning

confidence: 99%

Retinal haemorrhages in inflicted traumatic brain injury: the ophthalmologist in court

Vincent

Kelly

2010

Clinical Exper Ophthalmology

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“…Terson Syndrome is often observed after rupturing of an aneurysm of the anterior circulation, especially of the anterior communicating artery or the internal carotid artery [9] , and this was the case in our first patient who presented with a ruptured aneurysm of the internal carotid artery at the level of its supraclinoid segment. Other rare causes include aneurysms of the posterior circulation or aneurysmal rupture of the vertebral artery [10] , subdural hematoma, and post-traumatic bleeding with severe brain damage [11] , as in the case of our second patient, where Terson syndrome followed a bifrontal extradural hematoma of post-traumatic origin. The hypothesis of increased pressure in post-traumatic intracranial and intracerebral abnormalities would explain the occurrence of intravitreal hemorrhage in our second patient.…”

Section: Discussionmentioning

confidence: 60%

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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“…Similarly, TS has been described in spontaneous thoracic spinal SAH, presenting as a typical coup de poignard of Michon (40) and following spinal blood patch injection (41). Here TS is likely to have occurred due to blood extending into CSF and the subarachnoid space.…”

Section: Existing Theories and Their Flawsmentioning

confidence: 73%

An explanation for Terson syndrome at last: the glymphatic reflux theory

et al. 2021

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Terson Syndrome (TS) describes the presence of intraocular hemorrhage in patients with intracranial hemorrhage, typically subarachnoid hemorrhage. Despite TS being a well-defined and frequently occurring phenomenon, its pathophysiology remains controversial. This review will present the current understanding of TS, with view to describing a contemporary and more plausible pathomechanism of TS, given recent advances in ophthalmic science and neurobiology. Previously proposed theories include a sudden rise in intracranial pressure (ICP) transmitted to the optic nerve sheath leading to rupture of retinal vessels; or intracranial blood extending to the orbit via the optic nerve sheath. The origin of blood in TS is uncertain, but retinal vessels appear to be an unlikely source. In addition, an anatomical pathway for blood to enter the eye from the intracranial space remains poorly defined. An ocular glymphatic system has recently been described, drainage of which from the globe into intracranial glymphatics is reliant on the pressure gradient between intraocular pressure and intracranial pressure. The glymphatic pathway is the only extravascular anatomical conduit between the subarachnoid space and the retina. We propose that subarachnoid blood in skull base cisterns near the optic nerve is the substrate of blood in TS. Raised ICP causes it to be refluxed through glymphatic channels into the globe, resulting in intraocular hemorrhage. We herewith present glymphatic reflux as an alternative theory to explain the phenomenon of Terson Syndrome. Response to Reviewers:Many thanks, please see the attached Word document which contains all responses to reviewer and editor comments in red. These are copied below as well.

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Terson’s syndrome in spontaneous spinal subarachnoid haemorrhage

Cited by 13 publications

References 7 publications

Retinal haemorrhages in inflicted traumatic brain injury: the ophthalmologist in court

Retinal haemorrhages in inflicted traumatic brain injury: the ophthalmologist in court

Terson syndrome: Two case reports

An explanation for Terson syndrome at last: the glymphatic reflux theory

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