gms | German Medical Science

Objective: Terson-Syndrome (TS) in patients suffering from subarachnoid hemorrhage (SAH) may affect approximately 20% of all aneurysmal SAH-patients according to our previous prospective study of 83 patients. Nevertheless the pathomechanism of TS remains unclear. A sudden increase in intracranial pressure may displace subarachnoid blood into the orbit via the optic nerve sheet. If this mechanism is the main pathway for TS, we assumed that there should be a correlation of site of intraocular bleeding and site of ruptured aneurysm.

Method: 20 patients suffering from SAH and TS were retrospectively evaluated for site of TS and ruptured aneurysm. Anterior circulation aneurysms were separated into two groups due to their blood supply from either right or left carotid artery. TS was divided into two groups (right eye, left eye). Positive correlation was set to have TS on the same side as aneurysm or in both eyes if the dominant intraocular bleeding was seen on the same side as aneurysm. Statistical tests were done by exact binominal test and Clopper Pearson test.

Results: In total 80% of SAH-patients were diagnosed to have a TS correlating to the site of aneurysm (p=0.012; 95% confidence interval: 0.56-0.94). In 12 SAH-patients MCA-, ACA- and ICA-aneurysms were right sided matching with TS which was seen in 11 of these 12 patients on the right side. In four patients with ruptured aneurysm of the left side six patients had TS in their left eye. In two patients PICA-aneurysm (one right sided aneurysm with TS on left side and one left sided aneurysm with TS on the left side) were found. The median age of these 20 patients was 49.4 ± 10.35. A high Hunt & Hess grade with 3.9 ± 1.25, a low GCS of 8.0 ± 5.40 and high Fisher grade (3.90 ± 0.315) are demonstrating that especially patients with severe course of SAH suffering from TS.

Conclusions: Our study underlines the pathological concept of TS showing a positive correlation of aneurysm site and site of TS. Further experimental studies are on the way to validate the mechanism of TS. According to the high percentage of TS found in aneurysmal SAH we recommend ophthalmological examination as a routine procedure thereby obtaining further data which may elucidate our understanding of TS.