Terson syndrome and leukemia: a case report

Lorenzi, Umberto; Buschini, Elisa; Fea, Antonio; Machetta, Federica; Grignolo, Fm

doi:10.2147/opth.s52548

Cited by 6 publications

(2 citation statements)

References 6 publications

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“…Intracranial hemorrhage is the second most common complication, after infection, among adults with hematologic malignant conditions, and it is often the presenting sign of CNS involvement . Terson syndrome has been described in the context of systemic CML but not with concurrent CNS involvement . This case represents the rare occurrence of Terson syndrome leading to the diagnosis of extramedullary CML in the CNS.…”

Section: Discussionmentioning

confidence: 87%

Blurry Vision in a Patient With Leukemia

2022

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A 57-year-old man with chronic myelogenous leukemia (CML) refractory to multiple tyrosine kinase inhibitors (ie, imatinib, nilotinib, and bosutinib) presented for subacute-onset blurry vision in both eyes. He had been admitted for an upcoming bone marrow transplant. The patient had floaters without flashes and denied any eye pain. A review of symptoms found chronic fatigue and a new, mild headache beginning a few days prior. On examination, his visual acuity was 20/50 OU; intraocular pressures were 15 mm Hg OD and 13 mm Hg OS; and pupils were equal, round, and reactive, without a relative afferent pupillary defect. Extraocular movements, confrontational visual fields, and Ishihara color plates were full. An anterior segment examination had normal results. A fundus examination revealed clinically significant peripapillary intraretinal and preretinal hemorrhages obscuring the optic disc margins of both eyes (Figure 1). A peripheral retinal examination of both eyes had normal results. Diagnosis Terson syndrome in a patient with CML with central nervous system involvement What to Do Next C. Magnetic resonance imaging of the brain and orbits DiscussionThis patient, who had refractory CML and blurry vision, presented with bilateral peripapillary hemorrhages and whitening suggestive of possible optic nerve edema. His presentation was concerning for leuke-

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Section: Discussionmentioning

confidence: 87%

Blurry Vision in a Patient With Leukemia

2022

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“…Monitoring is then clinical but also radiological by ocular ultrasound or even other explorations such as OCT. [2] , [14] If the hemorrhage does not resolve or does not progress well, a pars plana vitrectomy is indicated, especially for intravitreal hemorrhage [5] , [14] . However, a surgical approach is not possible in the presence of intraretinal hemorrhage [15] . It should also be noted that immediate vitrectomy for intraocular hemorrhage is not recommended, except in cases of sub-macular hemorrhage, binocular damage with severe visual loss, or in pediatric patients at risk of amblyopia [5] .…”

Section: Discussionmentioning

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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A Case of Terson-Like Syndrome in a Patient with Viral Meningoencephalitis

Asahi

Weiss

Peddada

et al. 2019

Case Reports in Ophthalmological Medicine

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The proposed mechanism of Terson’s syndrome is increased intracranial pressure that leads to dilation of the retrobulbar optic nerve and compression of the central retinal vein. Terson’s syndrome has been associated with many conditions that increase intracranial pressure such as venous sinus thrombosis, Moyamoya disease, leukemia, direct head trauma, and intraocular hemorrhage related to shaken baby syndrome. We present a novel case of a patient with recent viral prodrome found to have papilledema and multilayered retinal hemorrhages consistent with Terson syndrome. Computed tomography and magnetic resonance venography of the brain did not reveal any subdural, subarachnoid, or intracranial hemorrhages. However, cerebrospinal fluid analyses were significant for increased opening pressure and elevated protein levels, which were suggestive of viral meningoencephalitis. We describe this case as a Terson-like syndrome because the etiology of intraocular hemorrhage is increased intracranial pressure. However, this case does not fit the traditional presentation of Terson’s syndrome as the intracranial pressure is secondary to meningeal inflammation instead of subdural, subarachnoid, or intracranial hemorrhage. We strongly feel that it is important for physicians to be aware of the link between viral meningoencephalitis and retinal conditions such as Terson-like syndrome because it can facilitate rapid diagnosis and treatment.

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Terson syndrome and leukemia: a case report

Cited by 6 publications

References 6 publications

Blurry Vision in a Patient With Leukemia

Blurry Vision in a Patient With Leukemia

Terson syndrome: Two case reports

A Case of Terson-Like Syndrome in a Patient with Viral Meningoencephalitis

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