Terson syndrome: Two case reports

• Published in: International journal of surgery case reports 2022-01, Vol.90, p.106700-106700, Article 106700
• Main Authors: Issiaka, Moctar, Mchachi, Adil, Rachid, Rayad, Belhadji, Mohamed E.L., Mahazou, Ismael, Banao, Maimouna
• Format: Article
• Language: English
• Subjects: Case Report; Intracranial hemorrhage; Intraocular hemorrhage; Rupture of aneurysm; Terson syndrome; Traumatic brain injury
• ISSN: 2210-2612; 2210-2612
• DOI: 10.1016/j.ijscr.2021.106700

Vitreous or retinal hemorrhage occurring in association with subarachnoid hemorrhage (SAH) is known as Terson syndrome (TS). Its incidence is of the order of 10–50% after subarachnoid hemorrhage. We report two cases of TS with different clinical presentations, different managements, and a good final prognosis, which were managed at the Ibn Rochd hospital in Casablanca. We report two cases of TS. The first one occurred in a 55-year-old hypertensive man following a ruptured aneurysm of the internal carotid artery, revealed by a decrease in visual acuity concomitant with the neurological symptomatology. The evolution was favorable after specialized neurological management and spontaneous resorption of the intravitreal hemorrhage was obtained 3 months after the acute episode with good visual recovery. The second case was that of a 45-year-old man who presented with an intravitreal hemorrhage of the right eye, 24 h after severe head trauma responsible for a bifrontal extradural hematoma. The B-mode ocular ultrasound discovery of a retinal detachment with persistent hemorrhage led to the indication of a pars plana vitrectomy with retinal tamponade, which allowed visual rehabilitation without recurrence after 1 year. Ophthalmologic evaluation by specialized examination and radiology (ocular ultrasound, OCT) is necessary for all patients with TS because early diagnosis and treatment can prevent visual loss and associated complications. Treatment of TS can be conservative and based on periodic monitoring. A pars plana vitrectomy is considered in some cases. •The etiopathogenesis of TS has been controversial since its appearance.•The latest studies speak of a mechanism: the theory of glymphatic reflux•TS may occur in an atraumatic context but there is often the notion of intracranial hyperpressure.•The prognosis remains better in the absence of other complications and cases of early and adequate management.