Terson's syndrome in the context of intracranial hemorrhage

A 62-year-old man was admitted with a hypertensive emergency, anisocoria and decreased level of consciousness. The CT scan showed a hemorrhage in the brainstem and an intraocular hemorrhage ([Figure]), consistent with Terson's syndrome, a condition that is classically characterized as a vitreous hemorrhage secondary to a subarachnoid hemorrhage. However, it can also be considered as a traumatic hemorrhage and, more rarely, as an intraparenchymal hemorrhage. The etiology has been attributed to a rapid increase in intracranial pressure, resulting in reduced retinal venous drainage and leading to vitreous bleeding. Terson's syndrome is associated a high rate of morbidity and mortality not only in patients with subarachnoid hemorrhage[1],[2],[3],[4],[5].

Figure Computed tomography (CT) showed a hemorrhage in the brainstem and in the vermis of the cerebellum (black arrow in A) and an intraocular hemorrhage in the right eye (white arrow in B), which appeared as spontaneously hyperdense areas on the CT.

Referenzen

References
1 Joswig H, Epprecht L, Valmaggia C, Leschka S, Hildebrandt G, Fournier JY et al. Terson syndrome in aneurysmal subarachnoid hemorrhage-its relation to intracranial pressure, admission factors, and clinical outcome. Acta Neurochir (Wien). 2016;158(6):1027-36. https://doi.org/10.1007/s00701-016-2766-8
2 Czorlich P Skevas C, Knospe V, Vettorazzi E, Richard G, Wagenfeld L et al. Terson syndrome in subarachnoid hemorrhage, intracerebral hemorrhage, and traumatic brain injury. Neurosurg Rev. 2015;38(1):129-36. https://doi.org/10.1007/s10143-014-0564-4
3 Takkar A, Kesav P, Lal V, Gupta A. Teaching neuroimages: Terson syndrome in cortical venous sinus thrombosis. Neurology. 2013;81(6):e40-1.https://doi.org/10.1212/WNL.0b013e31829e6f13
4 Kim HS, Lee SW, Sung SK, Seo EK. Terson syndrome caused by intraventricular hemorrhage associated with moyamoya disease. J Korean Neurosurg Soc. 2012;51(6):367-9. https://doi.org/10.3340/jkns.2012.51.6.367
5 Kapoor S. Terson syndrome: an often overlooked complication of subarachnoid hemorrhage. World Neurosurg. 2014;81(1):e4. https://doi.org/10.1016/j.wneu.2013.08.012

Abbildungen

Figure Computed tomography (CT) showed a hemorrhage in the brainstem and in the vermis of the cerebellum (black arrow in A) and an intraocular hemorrhage in the right eye (white arrow in B), which appeared as spontaneously hyperdense areas on the CT.