A 52-Year-Old Man with Aneurysmal Subarachnoid Hemorrhage Associated with Delayed-Onset Vitreous Hemorrhage (Terson's Syndrome) Successfully Treated with Balloon-Assisted Coiling and Delayed Vitrectomy

Abstract

BACKGROUND Terson's syndrome (TS) is a medical condition characterized by intraocular bleeding that can lead to visual impairment and is associated to subarachnoid hemorrhage (SAH). The pathophysiology and natural history are not well established in the current literature. This report describes successful treatment of a 52-year-old man with aneurysmal SAH who developed late-onset TS using balloon-assisted coiling and vitrectomy to raise awareness of this important complication of aneurysmal SAH. CASE REPORT A 52-year-old smoker with no known past medical history presented to the emergency department with a sudden, severe headache that worsened with photophobia and phonophobia. The patient had a diffuse SAH and underwent an embolization procedure. After 48 hours of close Intensive Care Unit monitoring, the patient's vital signs were stable, and the GCS score was consistently 15/15. However, after 3 weeks in the hospital, the patient experienced blurred vision and a right upper quadrantanopia. Further examination revealed TS and the patient underwent a vitrectomy in 1 eye. The surgery was successful and the eye recovered to 20/20 with no complications. However, the other eye showed slow absorption of the hemorrhage, and a vitrectomy was scheduled for that eye as well. CONCLUSIONS TS is a complication of aneurysmal SAH that can lead to vision loss and increased morbidity. It often goes undiagnosed, and ophthalmologists are not regularly consulted. Late manifestation of the condition is exemplified by the present case. Early detection and intervention are crucial for better patient outcomes.

Figure 1.

Initial non-contrast computed tomography scan, transverse plane, at the level of the midbrain. The red arrow points to the aneurysmal subarachnoid hemorrhage in the basal cistern.

Figure 2.

Initial non-contrast computed tomography scan, transverse plane, at the level of the third ventricle. The red arrow points to a subarachnoid hemorrhage located in the right temporal lobe. The blue arrow points to an intracerebral hemorrhage on the right frontal lobe.

Figure 3.

Initial computed tomography angiography, 3-dimensional reconstruction of the ruptured aneurysm. The red arrow points to the aneurysmal dome.

Figure 4.

Digital subtraction angiography of the left internal carotid artery. On the left is the image before the treatment of the aneurysm. The blue arrow points to the aneurysmal dome. On the right is the image of the same vessel after coiling the aneurysm. The black arrow points to the area of the aneurysm that is successfully occluded.

Figure 5.

Ocular sonography of the first affected eye. The red arrows indicate fresh hemorrhage, diagnosing vitreous hemorrhage.