A Case of Terson-Like Syndrome in a Patient with Viral Meningoencephalitis

Case Reports in Ophthalmological Medicine. 2019;2019 DOI 10.1155/2019/9650675

 

Journal Homepage

Journal Title: Case Reports in Ophthalmological Medicine

ISSN: 2090-6722 (Print); 2090-6730 (Online)

Publisher: Hindawi Limited

LCC Subject Category: Medicine: Ophthalmology

Country of publisher: United Kingdom

Language of fulltext: English

Full-text formats available: PDF, HTML, ePUB, XML

 

AUTHORS


Masumi G. Asahi (Western University of Health Sciences, 309 E 2nd St., Pomona, CA 91766, USA)

Stephanie J. Weiss (Drexel University College of Medicine, 219 N. Broad St., 3rd Floor, Philadelphia, PA 19107, USA)

Krishi Peddada (Drexel University College of Medicine, 219 N. Broad St., 3rd Floor, Philadelphia, PA 19107, USA)

Deepika Malik (Drexel University College of Medicine, 219 N. Broad St., 3rd Floor, Philadelphia, PA 19107, USA)

EDITORIAL INFORMATION

Blind peer review

Editorial Board

Instructions for authors

Time From Submission to Publication: 14 weeks

 

Abstract | Full Text

The proposed mechanism of Terson’s syndrome is increased intracranial pressure that leads to dilation of the retrobulbar optic nerve and compression of the central retinal vein. Terson’s syndrome has been associated with many conditions that increase intracranial pressure such as venous sinus thrombosis, Moyamoya disease, leukemia, direct head trauma, and intraocular hemorrhage related to shaken baby syndrome. We present a novel case of a patient with recent viral prodrome found to have papilledema and multilayered retinal hemorrhages consistent with Terson syndrome. Computed tomography and magnetic resonance venography of the brain did not reveal any subdural, subarachnoid, or intracranial hemorrhages. However, cerebrospinal fluid analyses were significant for increased opening pressure and elevated protein levels, which were suggestive of viral meningoencephalitis. We describe this case as a Terson-like syndrome because the etiology of intraocular hemorrhage is increased intracranial pressure. However, this case does not fit the traditional presentation of Terson’s syndrome as the intracranial pressure is secondary to meningeal inflammation instead of subdural, subarachnoid, or intracranial hemorrhage. We strongly feel that it is important for physicians to be aware of the link between viral meningoencephalitis and retinal conditions such as Terson-like syndrome because it can facilitate rapid diagnosis and treatment.