Terson's syndrome: neurosurgical considerations on the subject of a rare case with ophthalmological sequelae

Abstract

According to prospective studies, vitreous hemorrhage may be diagnosed in 8%-27% of the patients with aneurysmal subarachnoid hemorrhage (SAH) (Terson's syndrome) and has been associated with a bad neurological outcome. In spite of its incidence and prognostic value, vitreous hemorrhage is underdiagnosed. We describe the case of a 48 year-old woman who was diagnosed with a SAH due to the rupture of an aneurysm of the right middle cerebral artery bifurcation that was surgically treated with minimal neurological morbidity. However, due to vitreous hemorrhage in the right eye, the patient developed visual loss that did not recovered after proper surgical treatment. In the context of the present case we take a timely review of the literature, discussing the incidence, pathophysiology, treatment and prognosis of Terson's syndrome. The reported case stresses that the natural history of Terson's syndrome is not always synonymous with good outcome. Significant visual sequelae due to vitreous hemorrhage are very rare after proper conservative or surgical treatment. The severe visual loss of this patient emphasizes the need for a systematic, early and serial ophthalmological evaluation of all patients with aneurysmal SAH.

Keywords

• intracranial aneurysm
• vitreous hemorrhage
• subarachnoid hemorrhage