Title

TERSON SYNDROME

Introduction

Purpose: To show the retinal involvement in a patient with subarachnoid hemorrhage (SAH).

Methods

65-year-old woman admitted to the intensive care unit of Hospital Alemão Oswaldo Cruz for the treatment of acute subarachnoid hemorrhage, had red eye, and an ophthalmological evaluation was requested Upon examination, a sedated patient presented with hyposphagma and chemosis in the right eye, and no changes in the left eye. Fundoscopy showed multiple hemorrhage points in the middle periphery of both eyes, and the hypothesis of terson syndrome was raised.

Results

This case shows the importance of fundoscopy in patients with subarachnoid hemorrhage, even in the absence of visual complaints. Neurological outcomes and mortality rate are worse in patients with SAH and Terson syndrome than patients with SAH alone.

Discussion

Terson syndrome is recognized as intraocular hemorrhage associated with SAH,intracerebral hemorrhage,or traumatic brain injury.Hemorrhage may be present in the vitreous, sub-hyaloid or intraretina/sub-internal limiting membrane.Most commonly in subarachnoid hemorrhages due to ruptured cerebral aneurysms.Although early studies attempted to link this syndrome with aneurysms of the anterior communicating artery, statistical analysis has not correlated it with a specific aneurysmal location.Other reports include such causes as strangulation, trauma, hypertension, tumor, and perioperative and postoperative intracranial bleeding. Hemorrhages usually resolve spontaneously within six to twelve months and hence conservative management is the rule. Vision loss is usually reversible but permanent impairment of vision can occur.

Keywords

terson syndrome

Area

CLINICAL CASE

Authors

Paulo Kin Takara, Monique Viana Sousa, Janaina Lucila Brabo, Ione Feijao Alexim