Terson's Syndrome in Aneurysmal Subarachnoid Hemorrhage

ABSTRACT

Terson's syndrome is the oculocerebral syndrome of retinal and vitreous hemorrhage associated with spontaneous subarachnoid hemorrhage(SAH) or all forms of intracranial bleeding. Recent observations indicate that the patients with spontaneous subarachnoid hemorrhage have an 18% to 20% concurrent incidence of retinal and vitreous hemorrhages and about 4% incidence of viterous hemorrhage alone. Therefore, clinical ophthalmologic findings may have a significant diagnostic and prognostic value for the clinician. Total of 627 consecutive patients with aneurysmal subarachnoid hemorrhage were retrospectively studied by means of indirect fundoscopy to address the question of occur and prognostic implications of vitreous hemorrhage after subarachnoid hemorrhage from January 1993 to December 1996. Among these, we experienced 21 patients with vitreous hemorrhage(Terson's syndrome). The patients with vitreous hemorrhage commonly occurred in anterior communicating and internal carotid artery aneurysm. Twelve patients had intraocular hemorrhage within 48 hours after SAH. There were bilateral involvement in 15 cases, and the 14 experienced complete recovery of vision following massive intravitreal hemorrhage. A favorable surgical outcome was obtained in 14 of 21 patients(66.7%) and a satisfactory result in vision was achieved in 15 cases among 17 survivors(88.2%). From these results, we emphasize the significance of ocular findings in patients with aneurysmal subarachnoid hemorrhage.