eMedicine Specialties > Ophthalmology > Retina

Terson Syndrome: Workup

Author: Richard J Ou, MD, Clinical Assistant Professor, Baylor College of Medicine; Attending Physician and Consultant, Michael E DeBakey Veterans Affairs Medical Center
Coauthor(s): Marc O Yoshizumi, MD, Director of Eye Trauma and Emergency Center, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles
Contributor Information and Disclosures

Updated: Jul 3, 2008

Workup

Laboratory Studies

  • Terson syndrome can be diagnosed by its unique clinical presentation of simultaneous intracranial and intraocular hemorrhage. A thorough history must be obtained to rule out causes of preexisting intraocular hemorrhages (eg, diabetic retinopathy, age-related macular degeneration, sickle cell disease, intraocular tumor). In cases associated with trauma, a posterior vitreous detachment, retinal break, or retinal detachment also must be ruled out.
  • Sickle cell preparation
  • Glucose level and glucose tolerance test to rule out diabetes

Imaging Studies

  • Neuroimaging studies, including CT scan, MRI, or angiography, are necessary to document intracranial hemorrhage.
  • B-scan ultrasound may be necessary to determine the severity of vitreous hemorrhage and to rule out a retinal detachment if no view to the posterior pole is possible, particularly in the setting of trauma.

Other Tests

  • Examination of the cerebrospinal fluid should be deferred to a neurologist.

Diagnostic Procedures

  • Both a history and a clinical examination are indicated to help diagnose this condition.

Histologic Findings

Pathologic specimens of patients with Terson syndrome have shown abundant erythrocytes with occasional leukocytes in the vitreous, subhyaloidal and subinternal limiting membrane space, and retina. Clinical case reports have documented subretinal blood, but this is not as common. Epiretinal membranes examined in Terson syndrome show glial cells and basement membrane material.

Staging

No staging currently exists.

More on Terson Syndrome

Overview: Terson Syndrome
Workup: Terson Syndrome
Treatment: Terson Syndrome
Follow-up: Terson Syndrome
Multimedia: Terson Syndrome
References
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References

  1. Litten M. Ueber einige vom allegmein-klinischen Standpunkt aus interessante Augenveranderungen. Berl Klin Wochnschr. 1881;18:23-27.

  2. Fahmy JA. Fundal haemorrhages in ruptured intracranial aneurysms. I. Material, frequency and morphology. Acta Ophthalmol (Copenh). 1973;51(3):289-98. [Medline].

  3. Fahmy JA. Fundal haemorrhages in ruptured intracranial aneurysms. II. Correlation with the clinical course. Acta Ophthalmol (Copenh). 1973;51(3):299-304. [Medline].

  4. Frizzell RT, Kuhn F, Morris R, et al. Screening for ocular hemorrhages in patients with ruptured cerebral aneurysms: a prospective study of 99 patients. Neurosurgery. Sep 1997;41(3):529-33; discussion 533-4. [Medline].

  5. Garcia-Arumí J, Corcostegui B, Tallada N, et al. Epiretinal membranes in Tersons syndrome. A clinicopathologic study. Retina. 1994;14(4):351-5. [Medline].

  6. Gnanaraj L, Tyagi AK, Cottrell DG, et al. Referral delay and ocular surgical outcome in Terson syndrome. Retina. 2000;20(4):374-7. [Medline].

  7. Heyreh SS. An experimental study of the central retinal vein occlusion. Trans Ophthalmol Soc UK. 1964;84:586-98.

  8. Khan SG, Frenkel M. Intravitreal hemorrhage associated with rapid increase in intracranial pressure (Terson's syndrome). Am J Ophthalmol. Jul 1975;80(1):37-43. [Medline].

  9. Kuhn F, Morris R, Witherspoon CD, et al. Terson syndrome. Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. Ophthalmology. Mar 1998;105(3):472-7. [Medline].

  10. McCarron MO, Alberts MJ, McCarron P. A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. Mar 2004;75(3):491-3. [Medline].

  11. Medele RJ, Stummer W, Mueller AJ, et al. Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure. J Neurosurg. May 1998;88(5):851-4. [Medline].

  12. Ness T, Janknecht P, Berghorn C. Frequency of ocular hemorrhages in patients with subarachnoidal hemorrhage. Graefes Arch Clin Exp Ophthalmol. Sep 2005;243(9):859-62. [Medline].

  13. Ogawa T, Kitaoka T, Dake Y, et al. Terson syndrome: a case report suggesting the mechanism of vitreous hemorrhage. Ophthalmology. Sep 2001;108(9):1654-6. [Medline].

  14. Pfausler B, Belcl R, Metzler R, et al. Terson's syndrome in spontaneous subarachnoid hemorrhage: a prospective study in 60 consecutive patients. J Neurosurg. Sep 1996;85(3):392-4. [Medline].

  15. Rubowitz A, Desai U. Nontraumatic macular holes associated with Terson syndrome. Retina. Feb 2006;26(2):230-2. [Medline].

  16. Schultz PN, Sobol WM, Weingeist TA. Long-term visual outcome in Terson syndrome. Ophthalmology. Dec 1991;98(12):1814-9. [Medline].

  17. Shaw HE Jr, Landers MB, Sydnor CF. The significance of intraocular hemorrhages due to subarachnoid hemorrhage. Ann Ophthalmol. Nov 1977;9(11):1403-5. [Medline].

  18. Toosi SH, Malton M. Terson's syndrome--significance of ocular findings. Ann Ophthalmol. Jan 1987;19(1):7-12. [Medline].

  19. Vrabec TR, Sergott RC, Savino PJ, et al. Intermittent obstructive hydrocephalus in the Arnold-Chiari malformation. Ann Neurol. Sep 1989;26(3):401-4. [Medline].

  20. Weingeist TA, Goldman EJ, Folk JC, et al. Terson's syndrome. Clinicopathologic correlations. Ophthalmology. Nov 1986;93(11):1435-42. [Medline].

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Further Reading

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Keywords

Terson’s syndrome, vitreous hemorrhage, subhyaloid hemorrhage, retinal hemorrhage, subarachnoid hemorrhage, intraocular hemorrhage, intracranial bleeding, increased intracranial pressure

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Contributor Information and Disclosures

Author

Richard J Ou, MD, Clinical Assistant Professor, Baylor College of Medicine; Attending Physician and Consultant, Michael E DeBakey Veterans Affairs Medical Center
Richard J Ou, MD is a member of the following medical societies: American Academy of Ophthalmology, American Medical Association, Harris County Medical Society, and Texas Medical Association
Disclosure: Nothing to disclose.

Coauthor(s)

Marc O Yoshizumi, MD, Director of Eye Trauma and Emergency Center, Professor, Department of Ophthalmology, Jules Stein Eye Institute, University of California at Los Angeles
Marc O Yoshizumi, MD is a member of the following medical societies: American Academy of Ophthalmology
Disclosure: Nothing to disclose.

Medical Editor

Brian A Phillpotts, MD, Former Vitreo-Retinal Service Director, Former Program Director, Clinical Assistant Professor, Department of Ophthalmology, Howard University College of Medicine
Brian A Phillpotts, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, and National Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Steve Charles, MD, Director of Charles Retina Institute; Clinical Professor, Department of Ophthalmology, University of Tennessee College of Medicine
Steve Charles, MD is a member of the following medical societies: American Academy of Ophthalmology, American Society of Retina Specialists, Club Jules Gonin, Macula Society, and Retina Society
Disclosure: Alcon Laboratories Consulting fee Consulting; OptiMedica Ownership interest Consulting

CME Editor

Lance L Brown, OD, MD, Ophthalmologist, Affiliated With Freeman Hospital and St John's Hospital, Regional Eye Center, Joplin, Missouri
Disclosure: Nothing to disclose.

Chief Editor

Hampton Roy Sr, MD, Associate Clinical Professor, Department of Ophthalmology, University of Arkansas for Medical Sciences
Hampton Roy Sr, MD is a member of the following medical societies: American Academy of Ophthalmology, American College of Surgeons, and Pan-American Association of Ophthalmology
Disclosure: Nothing to disclose.

 
 
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