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CC BY-NC-ND 4.0 · Arq Neuropsiquiatr 2016; 74(06): 513
DOI: 10.1590/0004-282X20160057
IMAGES IN NEUROLOGY

Terson’s syndrome following an aneurysmal subarachnoid hemorrhage: an imaging prognostic finding you should recognize

Síndrome de Terson após hemorragia subaracnoidea: um achado prognóstico de imagem que você deve reconhecer
Douglas Mendes Nunes
1   Santa Casa de Misericórdia de São Paulo, Setor de Neurorradiologia, São Paulo SP, Brasil;
,
Bruna Garbugio Dutra
1   Santa Casa de Misericórdia de São Paulo, Setor de Neurorradiologia, São Paulo SP, Brasil;
,
Antçnio Carlos Martins Maia Júnior
1   Santa Casa de Misericórdia de São Paulo, Setor de Neurorradiologia, São Paulo SP, Brasil;
,
Reginaldo Carlos Boni
2   Santa Casa de Misericórdia de São Paulo, Serviço de Procura de Órgãos e Tecidos, São Paulo SP, Brasil.
,
Antçnio José da Rocha
1   Santa Casa de Misericórdia de São Paulo, Setor de Neurorradiologia, São Paulo SP, Brasil;
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Terson’s Syndrome (TS) was originally described as intraocular hemorrhage associated with aneurysmal subarachnoid hemorrhage (SAH)[1]. It is a consequence of sudden rise in intracranial pressure (IP) that reduces venous return to the cavernous sinus or obstruct the retinochoroidal anastomoses and central retinal vein, culminating in venous stasis and ocular hemorrhage ([Figure]). TS has also been reported in nonaneurysmal SAH, severe traumatic injuries or venous thrombosis[2].

Zoom Image
Figure 37 year-old woman with sudden headache progressed to seizures and decreased level of consciousness. Nonenhanced CT (A) showed basilar cisterns and sulcal effacement due to intracranial hypertension, additionally to subarachnoid hemorrhage that thickens and increases the attenuation of the tentorium cerebelli bilaterally (arrows). Note bilateral intraocular hemorrhage (arrowheads). The 3D-reconstruction of CTA (arterial phase) showed a berry aneurysm (arrow) in the supraclinoid segment of the right internal carotid artery (B). The coronal reformatted CTA image (C) and CT perfusion axial image (D), performed 4 days later, depicted absence of contrast opacification of intracranial vessels and diffusely absent cerebral blood flow, endorsing the concurrent diagnosis of brain death in the follow-up.

Current literature has highlighted TS as an important life-threatening prognostic finding[3],[4]. Recognizing TS on fundoscopy or CT is recommended and effective control of IP is imperative to reduce the risk of mortality in this critical setting[5].



Publication History

Received: 06 October 2015

Accepted: 28 March 2016

Article published online:
06 September 2023

© 2023. Academia Brasileira de Neurologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

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