gms | German Medical Science

56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e. V. (DGNC)
3èmes journées françaises de Neurochirurgie (SFNC)

Deutsche Gesellschaft für Neurochirurgie e. V.
Société Française de Neurochirurgie

07. bis 11.05.2005, Strasbourg

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Terson's syndrome as the only clinical presentation of a subarachnoidal bleeding: case presentation and review of the literature

Das Terson Syndrom als einziger klinischer Hinweis auf eine Subarachnoidalblutung: Fallbericht und Literaturvorstellung

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  • corresponding author L. Dörner - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • C. Alfke - Abteilung für Neuroradiologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • H. Barth - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel
  • H. M. Mehdorn - Klinik für Neurochirurgie, Universitätsklinikum Schleswig-Holstein, Campus Kiel

Deutsche Gesellschaft für Neurochirurgie. Société Française de Neurochirurgie. 56. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), 3èmes journées françaises de Neurochirurgie (SFNC). Strasbourg, 07.-11.05.2005. Düsseldorf, Köln: German Medical Science; 2005. DocP077

The electronic version of this article is the complete one and can be found online at: http://www.egms.de/en/meetings/dgnc2005/05dgnc0345.shtml

Published: May 4, 2005

© 2005 Dörner et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.

Outline

Text

Objective

The syndrome of vitreous or retinal hemorrhage occurring consequent to subarachnoidal bleeding is known as Terson's syndrome. It is thought to be related to an elevated ICP and to be accompanied by a bad clinical outcome. We present a case of a ruptured basilar artery aneurysm with bilateral vitreous hemorrhages but without any concomitant clinical symptoms except for a mild neck ache on that day.

Methods

A 61-year-old woman presented with an acute onset of visual loss for week to the ophthalmologist. In fundoscopy he documented a bilateral vitreous hemorrhage. A CCT was suspect for a subarachnoidal bleeding, so the patient was transferred for further diagnostics to our department. To confirm the questionable diagnosis we performed a lumbar puncture proving the suspected diagnosis. A cerebral angiography was performed and the found basilar aneurysm embolized with coils. A week later the patient could be discharged with improving eye sight.

Results

Terson's syndrome is seen in 10 to 20% of patients with subarachnoidal bleeding. Usually it is diagnosed secondary in the late course of the disease for example in the rehabilitation center because of visual deficits. A relation to an elevated ICP is discussed in literature. This case with no signs of intracranial pressure or meningeal irritation is contradictory to this theory and may support other hypotheses.

Conclusions

Terson's syndrome can be the only symptom of SAH caused by a ruptured aneurysm. A relation to an elevated ICP seems at least in this case unlikely. Further investigations to explain the pathophysiology of Terson`s syndrome appear necessary.