Pathogenesis of Terson syndrome
Purpose: The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. Methods: The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus...
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Published in | Indian journal of ophthalmology Vol. 70; no. 12; pp. 4130 - 4137 |
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Format | Journal Article |
Language | English |
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Wolters Kluwer India Pvt. Ltd
01.12.2022
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Abstract | Purpose: The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. Methods: The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed. Results: In eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages. Conclusion: The findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. This results in retinal venous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries and retinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss. |
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AbstractList | Purpose:The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial.Methods:The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed.Results:In eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages.Conclusion:The findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. This results in retinal venous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries and retinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss. The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. The central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed. In eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages. The findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. venous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries. retinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss. PurposeThe aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. MethodsThe central retinal artery (in 39 orbits), posterior ciliary arteries (in 8 orbits), and central retinal vein (CRV in 21 orbits) were occluded in rhesus monkeys by exposing them to lateral orbitotomy. Fundus examination and fluorescein fundus angiography were performed before and immediately after cutting the vessels and serially thereafter during the follow-up period. The rationale of the experimental study design is discussed. ResultsIn eyes with central retinal artery occlusion, retinal hemorrhages were seen soon after the procedure in 7 eyes, and on follow-up in a total of 15 eyes. In posterior ciliary artery occlusion, retinal hemorrhages were seen soon after the procedure in one eye, and on follow-up in a total of three eyes. In eyes with CRV, all eyes had extensive scattered retinal hemorrhages. ConclusionThe findings of this experimental study, and my basic, experimental, and comprehensive clinical studies on CRVO, suggest the following concept of the pathogenesis of TS: Compression of the CRV plays a crucial role in the development of TS. The CRV is compressed, as it lies in the subarachnoid space of the optic nerve sheath, by raised cerebrospinal fluid pressure and/or accumulated blood. . This results in retinalvenous stasis and raised venous pressure in the retinal veins, leading to venous engorgement, rupture of the retinal capillaries. andretinal hemorrhages. The clinical importance of compression of the CRV and not occlusion of CRV in TS is that optic nerve sheath decompression by opening it and releasing the blood and raised cerebrospinal fluid (CSF) pressure, would result in immediate decompressing of the CRV in the subarachnoid space and restoration of normal circulation and prevent visual loss. |
Audience | Professional |
Author | Hayreh, Sohan |
AuthorAffiliation | Department of Ophthalmology and Visual Sciences, College of Medicine, University of Iowa, Iowa City, Iowa, USA |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/36453300$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.1136/bjo.44.4.193 10.1007/s00415-021-10686-4 10.4103/ijo.IJO_1681_20 10.1136/bjo.49.12.626 10.1136/bjo.64.12.896 10.1097/IAE.0000000000000256 10.3171/jns.1998.88.5.0851 10.1016/j.jocn.2016.04.015 10.1007/s11064-015-1581-6 10.1159/000309386 10.1136/bjo.56.10.736 10.1016/0002-9394(66)90758-6 10.3171/jns.1974.41.2.0160 10.1016/j.preteyeres.2015.10.001 10.1097/01.iae.0000238095.97104.9b 10.1007/s00701-016-2766-8 |
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Keywords | Terson syndrome retinal hemorrhages subarachnoid hemorrhage Central retinal vein compression |
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References | Hayreh (R16-20240828) 1980; 64 Medele (R20-20240828) 1998; 88 Hayreh (R12-20240828) 2015 Hayreh (R11-20240828) 1965; 49 Hayreh (R9-20240828) 1984; 189 Muller (R6-20240828) 1974; 41 Kumaria (R7-20240828) 2022; 269 Hayreh (R17-20240828) 2021; 69 Czorlich (R3-20240828) 2016; 33 Hayreh (R19-20240828) 1977; 83 Hayreh (R15-20240828) 2007; 27 Hayreh (R14-20240828) 2015; 35 Litten (R1-20240828) 1881; 18 Hayreh (R18-20240828) 1972; 56 Hayreh (R10-20240828) 2016; 50 Terson (R2-20240828) 1900; 6 Jessen (R8-20240828) 2015; 40 Singh (R13-20240828) 1960; 44 Joswig (R4-20240828) 2016; 158 Hayreh (R5-20240828) 1966; 61 |
References_xml | – volume: 44 start-page: 193 year: 1960 ident: R13-20240828 article-title: The central artery of the retina I. Origin and course publication-title: Br J Ophthalmol doi: 10.1136/bjo.44.4.193 contributor: fullname: Singh – volume: 269 start-page: 1264 year: 2022 ident: R7-20240828 article-title: An explanation for Terson syndrome at last:The glymphatic reflux theory publication-title: J Neurol doi: 10.1007/s00415-021-10686-4 contributor: fullname: Kumaria – volume: 69 start-page: 227 year: 2021 ident: R17-20240828 article-title: Giant cell arteritis:Its ophthalmic manifestations publication-title: Indian J Ophthalmol doi: 10.4103/ijo.IJO_1681_20 contributor: fullname: Hayreh – volume: 49 start-page: 626 year: 1965 ident: R11-20240828 article-title: Occlusion of the central retinal vessels publication-title: Br J Ophthalmol doi: 10.1136/bjo.49.12.626 contributor: fullname: Hayreh – volume: 64 start-page: 896 year: 1980 ident: R16-20240828 article-title: Experimental occlusion of the central artery of the retina l. Ophthalmoscopic and fluorescein fundus angiographic studies publication-title: Br J Ophthalmol doi: 10.1136/bjo.64.12.896 contributor: fullname: Hayreh – volume: 35 start-page: 29 year: 2015 ident: R14-20240828 article-title: Fundus changes in central retinal vein occlusion publication-title: Retina doi: 10.1097/IAE.0000000000000256 contributor: fullname: Hayreh – volume: 83 start-page: OP379 year: 1977 ident: R19-20240828 article-title: Central retinal vein occlusion:Differential diagnosis and management publication-title: Trans Sect Ophthalmol Am Acad Ophthalmol Otolaryngol contributor: fullname: Hayreh – volume: 88 start-page: 851 year: 1998 ident: R20-20240828 article-title: Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure publication-title: J Neurosurg doi: 10.3171/jns.1998.88.5.0851 contributor: fullname: Medele – volume: 33 start-page: 182 year: 2016 ident: R3-20240828 article-title: Terson's syndrome-Pathophysiologic considerations of an underestimated concomitant disease in aneurysmal subarachnoid hemorrhage publication-title: J Clin Neurosci doi: 10.1016/j.jocn.2016.04.015 contributor: fullname: Czorlich – volume: 40 start-page: 2583 year: 2015 ident: R8-20240828 article-title: The glymphatic system:A beginner's guide publication-title: Neurochem Res doi: 10.1007/s11064-015-1581-6 contributor: fullname: Jessen – volume: 6 start-page: 309 year: 1900 ident: R2-20240828 article-title: De l'hémorrhagie dans le corps vitréau cours de l'hémorrhagiecérébrale publication-title: Clin Ophthalmol contributor: fullname: Terson – volume: 189 start-page: 54 year: 1984 ident: R9-20240828 article-title: The sheath of the optic nerve publication-title: Ophthalmologica doi: 10.1159/000309386 contributor: fullname: Hayreh – start-page: 621 year: 2015 ident: R12-20240828 article-title: Central retinal vein occlusion. In:Ocular Vascular Occlusive Disorders publication-title: Springer International Publishing contributor: fullname: Hayreh – volume: 56 start-page: 736 year: 1972 ident: R18-20240828 article-title: Occlusion of the posterior ciliary artery II. Chorio-retinal lesions publication-title: Br J Ophthalmol doi: 10.1136/bjo.56.10.736 contributor: fullname: Hayreh – volume: 61 start-page: 136 year: 1966 ident: R5-20240828 article-title: The structure of the head of the optic nerve in rhesus monkey publication-title: Am J Ophthalmol doi: 10.1016/0002-9394(66)90758-6 contributor: fullname: Hayreh – volume: 41 start-page: 160 year: 1974 ident: R6-20240828 article-title: Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension publication-title: J Neurosurg doi: 10.3171/jns.1974.41.2.0160 contributor: fullname: Muller – volume: 50 start-page: 108 year: 2016 ident: R10-20240828 article-title: Pathogenesis of optic disc edema in raised intracranial pressure publication-title: Prog Retin Eye Res doi: 10.1016/j.preteyeres.2015.10.001 contributor: fullname: Hayreh – volume: 18 start-page: 23 year: 1881 ident: R1-20240828 article-title: Über Einigevom Allgemein-Klinischen Standpunktaus Interessante Augenveränderungen publication-title: Berl Klin Wochenschr contributor: fullname: Litten – volume: 27 start-page: 276 year: 2007 ident: R15-20240828 article-title: Fundus changes in central retinal artery occlusion publication-title: Retina doi: 10.1097/01.iae.0000238095.97104.9b contributor: fullname: Hayreh – volume: 158 start-page: 1027 year: 2016 ident: R4-20240828 article-title: Terson syndrome in aneurysmal subarachnoid hemorrhage-its relation to intracranial pressure, admission factors, and clinical outcome publication-title: Acta Neurochir doi: 10.1007/s00701-016-2766-8 contributor: fullname: Joswig |
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Snippet | Purpose: The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. Methods: The central... The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. The central retinal artery... Purpose:The aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial.Methods:The central... PurposeThe aim of this experimental study was to investigate the pathogenesis of Terson syndrome (TS), which currently is controversial. MethodsThe central... |
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SubjectTerms | Angiography Arteries Blood pressure Capillaries Care and treatment central retinal vein compression Cerebrospinal fluid Compression Decompression Development and progression Engorgement Eye Fluorescein Hemorrhage Humans Occlusion Ophthalmic Artery Optic nerve Pathogenesis Retina Retinal Artery Retinal hemorrhage Retinal Hemorrhage - diagnosis Retinal Hemorrhage - etiology retinal hemorrhages Retinal Vein Special Original - A Tribute to Prof Sohan Singh Hayreh subarachnoid hemorrhage Subarachnoid space terson syndrome Veins & arteries |
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Title | Pathogenesis of Terson syndrome |
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