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Terson Syndrome Workup

  • Author: Richard J Ou, MD, FACS; Chief Editor: Hampton Roy, Sr, MD  more...
 
Updated: Jun 16, 2016
 

Approach Considerations

The criterion standard for diagnosis is dilated funduscopic examination in the setting of intracranial hemorrhage or another cause of rapidly increased intracranial pressure. The intraocular hemorrhage should be easily visible to the trained examiner. Terson syndrome should be strongly suspected in cases of severe subarachnoid hemorrhage.

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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. Typically, laboratory studies are not critical in making the diagnosis.

Sickle cell preparation may be considered.

Glucose and HbA1c testing may be performed to rule out diabetes, if applicable.

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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 retina is possible, particularly in the setting of trauma.

CT scans have been shown to be inferior to B-scan ultrasonography in identifying intraocular hemorrhage.[29]

Visually evoked potentials has been reported to identify Terson syndrome in a patient who was unable to communicate prior to a full dilated examination.[27]

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Other Tests

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

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Diagnostic Procedures

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

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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.[9]

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Staging

No staging currently exists.

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Contributor Information and Disclosures
Author

Richard J Ou, MD, FACS Clinical Assistant Professor, Baylor College of Medicine; Attending Physician and Consultant, Michael E DeBakey Veterans Affairs Medical Center; Partner, Houston Eye Associates

Richard J Ou, MD, FACS is a member of the following medical societies: American Academy of Ophthalmology, Harris County Medical Society

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

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, Macula Society, Retina Society, Club Jules Gonin

Disclosure: Received royalty and consulting fees for: Alcon Laboratories.

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, Pan-American Association of Ophthalmology

Disclosure: Nothing to disclose.

Additional Contributors

Brian A Phillpotts, MD, MD 

Brian A Phillpotts, MD, MD is a member of the following medical societies: American Academy of Ophthalmology, American Diabetes Association, American Medical Association, National Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

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.

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Right eye of a 28-year-old female with subarachnoid hemorrhage 1 week after intracranial surgery.
Left eye of a 28-year-old female with subarachnoid hemorrhage 1 week after intracranial surgery.
 
 
 
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