Terson’s Syndrome: Case Report

Introduction: Terson's Syndrome, defined since 1900 as the association of vitreous or retinal hemorrhage with subarachnoid hemorrhage, has been extended to include all intraocular hemorrhages secondary to other causes acute intracranial hypertension.

Observation: We report the observation of a 50-year-old woman who presented with bilateral Terson’s syndrome following a rupture of a cerebral aneurysm.

The patient was admitted for disturbance of consciousness and neurologic deficit. Ophthalmoscope examination of the fundus of the eye found pre, intra, and subretinal hemorrhages in the left eye masking the papilla and macula and a small hemorrhagic spot in the pre-retina right eye. This aspect motivated the performance of an angio-MRI which revealed a subarachnoid hemorrhage secondary to the rupture of an aneurysm. The treatment consisted of embolization by coils by arteriography. The evolution was marked by the resorption of the subarachnoid hemorrhage and ocular hemorrhages with good visual recovery: 1 in the right eye and 0,8 in the left eye.

Discussion: The pathophysiology of Terson's syndrome is very controversial. It is associated with SAH in 2 to 27% of cases. Most of these hemorrhages are due to ruptures of aneurysms located in the lower part of the polygon of Willis. TS retinal hemorrhages can sit under, intra or pre-retinal, or diffuse in the vitreous and are easily detected by an examination of the fundus. Vitrectomy allows rapid visual recovery when spontaneous resorption is not obtained after a period of observation.

Conclusion: The early diagnosis of TS in all cases of SAH and IH will improve diagnostic and therapeutic management, and therefore the visual and vital prognosis of these patients. Hence the value of an examination of the fundus in any patient with disturbance of consciousness without obvious etiological context.