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Case Reports
. 2024 Aug 7;86(9):5618-5621.
doi: 10.1097/MS9.0000000000002435. eCollection 2024 Sep.

Terson syndrome in association with sub-arachnoid hemorrhage: a case report

Prakash Phuyal  1 , Suchit Thapa Chhetri  2 , Deepa Khanal  3 , Subash Phuyal  1 , Sushanta Paudel  2 , Dipson Hamal  2 , Bishal Regmi  2
Affiliations
Case Reports

Terson syndrome in association with sub-arachnoid hemorrhage: a case report

Prakash Phuyal et al. Ann Med Surg (Lond). .

Abstract

Introduction: Terson syndrome is characterized by intraocular hemorrhage, which includes retinal, subretinal, subhyaloid, and vitreous hemorrhages, typically associated with sub-arachnoid, intracerebral, and traumatic brain injuries. The incidence of Terson syndrome varies significantly, ranging from 10 to 40% following sub-arachnoid hemorrhage.

Case presentation: A 48-year-old woman presented to the emergency department with a loss of consciousness for 1 h, 8 h prior to presentation, accompanied by teeth clenching, upward rolling of eyes, and frothing from the mouth. A non-contrast-enhanced computed tomography scan of the head revealed sub-arachnoid hemorrhage. Two days post-admission, the patient experienced decreased vision. Visual acuity tests showed significant impairment, and fundus examination revealed vitreous hemorrhage in both eyes. Digital subtraction angiography identified an aneurysm in the V4 segment of the left vertebral artery. Following flow diverter placement, the patient's visual acuity improved and normalized after 21 days.

Discussion: Terson syndrome is often linked with sub-arachnoid hemorrhage due to elevated intracranial pressure. It frequently occurs with aneurysms of the anterior communicating or internal carotid arteries. Diagnosis is often delayed until after patient stabilization. Ophthalmic evaluations, such as fundoscopic examinations and ocular ultrasonography, are crucial for early detection. The presence of Terson Syndrome correlates with higher mortality rates in SAH patients. While spontaneous resolution of intraocular hemorrhage is common, some cases necessitate surgical intervention for quicker recovery.

Conclusion: Comprehensive ophthalmic assessments in sub-arachnoid hemorrhage patients are essential for early detection and intervention, potentially preventing long-term visual impairment.

Keywords: Terson syndrome; case report; sub-arachnoid hemorrhage; visual acuity.

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Conflict of interest statement

The authors declare no conflict of interest.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
Non-contrast-enhanced computed tomography of head showing sub-arachnoid hemorrhage.
Figure 2
Figure 2
(A, B) Fundoscopic examination showing collection of blood in the vitreous chamber of left and right eyes after sub-arachnoid hemorrhage.
Figure 3
Figure 3
Digital subtraction angiography (DSA) showing aneurysm of the V4 segment of the left vertebral artery.
See this image and copyright information in PMC

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