gms | German Medical Science

Objective: Terson-Syndrome (TS) in patients suffering from subarachnoid haemorrhage (SAH) has been known since 1900. Nevertheless only little data has been published on the subject to date. The aim of this prospective interdisciplinary study, which was approved by the local ethic committee (PV3611), was to evaluate the incidence and predisposing factors of this severe disorder in SAH patients.

Methods: All SAH patients who were admitted to our clinic over a ten-month period were screened for TS following written consent by the patient or by the legal representative. 58 patients in total were included in this study. Ophthalmological examination was performed on day one and day 14 after written consent. Statistical analyses included the t-test and chi-square tests to examine correlations between TS and gender, initial GCS score, Hunt & Hess grade and the indication for ICP-monitoring and/or external ventricular drainage.

Results: The incidence of TS was 17.2% (10/58) with a predominance among female patients (9/38; male patients 1/20). The initial GCS in patients with TS was 11.2 (mean), whereas patients without TS presented with a mean initial GCS of 13.9 (p = 0.036). The mean Hunt & Hess grade in patients with TS (3.10) was higher than in the group without TS (1.98; p = 0.036). Initial ICP was almost equal in both groups (3.02 mmHg with TS versus 4.20 mmHg without TS) which was not significant. All patients in whom TS was diagnosed required ICP-monitoring and/or external ventricular drainage and intensified ICU management compared to the group without TS (p = 0.009). To date 6 out of 10 patients with TS were able to be examined for their visual acuity in the long-run. Three patients presented with a reduction of their visual acuity of whom two required surgical intervention to improve or stabilize their defective sight.

Conclusions: Terson Syndrome may be present in about one-fifth of all SAH patients and may lead to functional blindness in some patients. To date two of the 58 patients had to operated on by the ophthalmologists to prevent imminent blindness following full recovery from their SAH. Further efforts will focus on alternative techniques for the diagnosis of TS that circumvent the necessity of drug-induced pupil dilatation which is undesirable in ventilated ICU-patients. Ultrasound or visual evoked potentials seem to be promising tools and are currently being evaluated.