Case of the Week
Section Editors: Matylda Machnowska1 and Anvita Pauranik2
1University of Toronto, Toronto, Ontario, Canada
2BC Children's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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October 6, 2016
Terson Syndrome
- Background:
- Terson syndrome was described in 1900 by Alfres Terson, a French ophthalmologist.
- It corresponds to a subhyloid hemorrhage with involvement of the vitreous in the setting of acute aneurysmal subarachnoid hemorrhage.
- It is thought to be due to a rapid increase in ICP.
- Depending on the diagnostic method and the definition used, the incidence varies from 8-46%.
- It is more commonly seen in ruptured ACommA aneurysms.
- The diagnosis of Terson syndrome is clinically important, as it is associated with significantly higher mortality1.
- Up to 77% of these cases are overlooked on daily reports2.
- Key Diagnostic Features:
- Findings can be quite subtle and may vary between slight retinal thickening to nodularity or crescent-shaped, increased density on the retinal surface.
- Differential Diagnoses:
- In the setting of acute SAH, a crescentic-shaped hyper density of the posterior globe is in keeping with Terson syndrome3.
- Beware of false positive CT findings, commonly due to volume averaging, at the rectus muscle insertions. True findings are most reliably seen adjacent to the optic nerve.
- Treatment:
- This condition often requires timely ophthalmologic intervention to prevent long term visual loss.
- The current patient had a re-bleed while undergoing emergency coiling of the anterior communicating artery aneurysm and died within 48 hours of presentation.
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