TERSON’S SYNDROME

Z. Jamaleddine, S. El Haddad, A. El Quessar

Service de Radiologie, Hopital Cheikh ZaidRabat - Morocco

Introduction

Terson’s syndrome is the association of vitreous or retinal haemorrhage with subarachnoid haemorrhage (SAH).

The diagnosis is typically made fundoscopically.

Objectives

To describe, the clinical, radiological characteristics of this syndrome.

To describe the therapeutic indications.

Materials and methods

Three cases hospitalised for subarachnoid haemorrhage (SAH) and secondary complicated by intravitreous haemorrhage.

Imaging exploration  based on:

Computer tomography 16 bars,

MRI 1.5 Tesla, 

Cerebral angiography. 

Ocular ultrasonography intravitreous haemorrhage.

All patients were treated by embolisation for the etiology of SAH : two aneurysms and one AVM.

SAH

37 years old woman,

Left hemiplegia.  

CASE 1

 After several sessions of embolization

  Three months later: loss of vision in a right eye 

Diagnosis of Terson syndrome 

Treatment: Vitrectomy after 5 months

Visual acuity improved immediately

  A 28 years old male

  Headache, vomiting and VI paralysis 

t

Case 2

  Ten days later : Blindness of left eye

Diagnosis of Terson syndrome 

Treatment: Vitrectomy after 2 months

Recovery of visual acuity

Woman of 51 years

Case 3

One week after: impairment of right visual acuity. 

Diagnosis of Terson syndrome 

Vitrectomy is programmed, despite a partial improvement of vision

Discussion

Terson syndrome mentioned for the first time in 1900.

Vitreous haemorrhage: <10% of ruptured intracranial aneurysm.

Bilateral: 14% - 60% of cases.

Intraocular haemorrhage

Adult Children

The rate in % 18 - 41 70

Discussion

Etiology:

Ruptured aneurysm

AVM

Traumatic cause = very rare.

Clinical manifestation: the significant decrease in visual acuity is the  most  common symptom.

The most commoncause

Ultrasound search:

Characteristic of intravitreous haemorrhage

Dense,

Mobile: feature of Terson syndrome

Abundant,

Posterior vitreous detachment usually total.

Retinal detachment

Vitrectomy has been shown to be extremely effective in clearing the vitreous haemorrhage

Indications:

Patients with intraocular bilateral haemorrhage 

There is not signs of spontaneous resorption after 1 to 3 month.

Conclusion

It appears necessary to examine visual acuity in case of subarachnoid haemorrhage for an early diagnosis and the better treatment of this rare syndrome.