Terson syndrome in aneurysmal subarachnoid hemorrhage—its relation to intracranial pressure, admission factors, and clinical outcome

• Published in: Acta neurochirurgica Vol. 158; no. 6; pp. 1027 - 1036
• Main Authors: Joswig, Holger, Epprecht, Lorenz, Valmaggia, Christophe, Leschka, Sebastian, Hildebrandt, Gerhard, Fournier, Jean-Yves, Stienen, Martin Nikolaus
• Format: Journal Article
• Language: English
• Published: Vienna Springer Vienna 01.06.2016; Springer Nature B.V
• Subjects: Adult; Aged; Aneurysm, Ruptured - complications; Clinical Article - Vascular; Clinical outcomes; Female; Humans; Interventional Radiology; Intracranial Pressure; Male; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Subarachnoid Hemorrhage - complications; Subarachnoid Hemorrhage - diagnosis; Surgical Orthopedics; Vitreous Hemorrhage - diagnosis; Vitreous Hemorrhage - epidemiology; Vitreous Hemorrhage - etiology; Terson syndrome; Subarachnoid hemorrhage; External ventricular drain; Ocular hemorrhage; Vitreous hemorrhage; Intracranial pressure; Retinal hemorrhage
• ISSN: 0001-6268; 0942-0940
• DOI: 10.1007/s00701-016-2766-8

Background A large number of reports have not been able to clarify the pathophysiology of Terson syndrome (TS) in aneurysmal subarachnoid hemorrhage (aSAH). Methods Prospective single-center study on aSAH patients. Fundoscopic and radiological signs of TS were assessed. The opening intracranial pressure (ICP) in patients who required a ventriculostomy was recorded with a manometer. Results Six out of 36 included patients had TS (16.7 %), which was associated with unfavorable admission scores. Twenty-nine patients (80.5 %) required ventriculostomy; TS was associated with higher ICP (median, 40 vs. 15 cm cmH 2 O, p  = .003); all patients with TS had pathological ICP values of >20 cmH 2 O. Patients with a ruptured aneurysm of the anterior cerebral artery complex were ten times as likely to suffer from TS (OR 10.0, 95 % CI 1.03–97.50). Detection of TS on CT had a sensitivity of 50 %, a specificity of 98.4 %, a positive predictive value of 83.3 %, and a negative predictive value of 92.4 %. Mortality was 45 times as high in patients with TS (OR 45.0, 95 % CI 3.86–524.7) and neurologic morbidity up until 3 months post-aSAH was significantly higher in patients with TS (mRS 4–6; 100 vs. 17 %; p  = .001). Conclusions Our findings demonstrate an association between raised ICP and the incidence of TS. TS should be ruled out in aSAH patients presenting comatose or with raised ICP to ensure upfront ophthalmological follow-up. In alert patients without visual complaints and a TS-negative CT scan, the likelihood for the presence of TS is very low.