Letter to the Editor
Atypical presentation of Terson syndrome: Presentation of a case
Presentación atípica de un Síndrome de Terson: A propósito de un caso
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Sánchez Ferreiro, L. Muñoz Bellido" "autores" => array:2 [ 0 => array:4 [ "nombre" => "A.V." "apellidos" => "Sánchez Ferreiro" "email" => array:1 [ 0 => "vanesaferreiro1980@yahoo.es" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">¿</span>" "identificador" => "cor0005" ] ] ] 1 => array:3 [ "nombre" => "L." "apellidos" => "Muñoz Bellido" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] ] ] "afiliaciones" => array:2 [ 0 => array:3 [ "entidad" => "Servicio de oftalmología, Hospital del Bierzo, Ponferrada, León, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de neurología, Hospital del Bierzo, Ponferrada, León, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Presentación atípica de un Síndrome de Terson: A propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 753 "Ancho" => 949 "Tamanyo" => 58744 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large subhyaloid haemorrhage of the left eye found in an examination of the back of the eye.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Subarachnoid haemorrhage (SAH) associated with vitreous haemorrhage was first described by French ophthalmologist Albert Terson in 1900.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> At present, any type of intracranial haemorrhage<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> accompanied by vitreous haemorrhage is known as Terson syndrome (TS). SAH generally occurs as a result of a ruptured cerebral aneurysm. It is relatively frequent, with an incidence accounting for 5% of all cases of cerebral vascular disease. In contrast, TS is exceptional. The mechanism by which SAH causes intraocular bleeding is a matter of debate.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1–3</span></a> A number of theories state that by means of a direct mechanism, blood is forced through the stem of the optic nerve and into the globe while the SAH is occurring.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a> Other authors suggest that vitreous haemorrhage is the result of venous hypertension and disruption of retinal vessels.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">In TS, most subarachnoid haemorrhages are caused by spontaneous rupture of an aneurysm. The 3 most common locations are the intracranial internal carotid artery, the bifurcation of the middle cerebral artery, and the superior part of the basilar artery. The anatomical location of the aneurysm has not been linked to the side on which TS appears. It has also been shown that anatomical proximity between the aneurysm and the vitreous cavity is not required in order for an intraocular haemorrhage to occur.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">We present a case study of a white male who came to the emergency department due to sudden headache accompanied by vomiting and loss of consciousness. These symptoms resulted from SAH due to ruptured aneurysm, which was diagnosed by computed tomography (CT). The patient regained consciousness in 24<span class="elsevierStyleHsp" style=""></span>h, which is very unusual; SAH patients normally remain in a coma for a longer period of time. The aneurysm was embolised several days later using a platinum microcoil. Nothing in the patient's medical history was relevant to the event. He was referred to an ophthalmologist due to loss of vision in the left eye (LE). Findings from the ophthalmic examination were normal, except for a large subhyaloid haemorrhage at the back of the LE that was affecting the macular area (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). The haemorrhage was treated with Nd:YAG laser posterior hyaloidotomy. This caused a dense extension of blood in the vitreous cavity which was reabsorbed in 2 months, and the patient's eyesight recovered. This treatment option was chosen because the intraocular haemorrhage did not resolve spontaneously, and because the patient's condition discouraged us from subjecting him to stressful situations such as additional surgical procedures.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">It is a well-known fact that the presence of TS is an indicator of SAH severity.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Most patients with TS remain unconscious for extended periods of time, as stated above, which is a sign of the magnitude of the condition. However, our patient's case was atypical, as he regained consciousness in 24<span class="elsevierStyleHsp" style=""></span>h. In one study, Pfauser et al.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> found very high mortality rates among TS patients. Diagnosis of TS is indicative of a very poor prognosis, and frequently associated with rebleed from the aneurysm.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Therefore, examining the back of the eye in patients with SAH is a simple, non-invasive procedure that can provide information about the prognosis for SAH<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a>; the outcome in our case, however, was atypical.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Sánchez Ferreiro AV, Muñoz Bellido L. Presentación atípica de un síndrome de Terson: A propósito de un caso. Neurología. 2012;27:380–1.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 753 "Ancho" => 949 "Tamanyo" => 58744 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Large subhyaloid haemorrhage of the left eye found in an examination of the back of the eye.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:4 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Screening for ocular hemorrhages in patients with ruptured cerebral aneurysms: a prospective study of 99 patients" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "R.T. 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| 2018 August | 17 | 2 | 19 |
| 2018 July | 17 | 2 | 19 |
| 2018 June | 8 | 0 | 8 |
| 2018 May | 15 | 2 | 17 |
| 2018 April | 41 | 1 | 42 |
| 2018 March | 21 | 3 | 24 |
| 2018 February | 10 | 1 | 11 |
| 2018 January | 18 | 2 | 20 |
| 2017 December | 15 | 0 | 15 |
| 2017 November | 15 | 2 | 17 |
| 2017 October | 27 | 2 | 29 |
| 2017 September | 22 | 2 | 24 |
| 2017 August | 24 | 4 | 28 |
| 2017 July | 18 | 4 | 22 |
| 2017 June | 16 | 16 | 32 |
| 2017 May | 25 | 3 | 28 |
| 2017 April | 18 | 7 | 25 |
| 2017 March | 15 | 32 | 47 |
| 2017 February | 18 | 1 | 19 |
| 2017 January | 17 | 0 | 17 |
| 2016 December | 31 | 9 | 40 |
| 2016 November | 33 | 3 | 36 |
| 2016 October | 49 | 6 | 55 |
| 2016 September | 54 | 13 | 67 |
| 2016 August | 45 | 15 | 60 |
| 2016 July | 28 | 3 | 31 |
| 2016 June | 34 | 6 | 40 |
| 2016 May | 23 | 24 | 47 |
| 2016 April | 33 | 16 | 49 |
| 2016 March | 46 | 28 | 74 |
| 2016 February | 36 | 17 | 53 |
| 2016 January | 22 | 14 | 36 |
| 2015 December | 20 | 14 | 34 |
| 2015 November | 12 | 13 | 25 |
| 2015 October | 17 | 16 | 33 |
| 2015 September | 29 | 8 | 37 |
| 2015 August | 14 | 12 | 26 |
| 2015 July | 24 | 5 | 29 |
| 2015 June | 4 | 1 | 5 |
| 2015 May | 15 | 6 | 21 |
| 2015 April | 21 | 13 | 34 |
| 2015 March | 7 | 11 | 18 |
| 2015 February | 20 | 8 | 28 |
| 2015 January | 35 | 8 | 43 |
| 2014 December | 40 | 12 | 52 |
| 2014 November | 21 | 1 | 22 |
| 2014 October | 32 | 8 | 40 |
| 2014 September | 26 | 3 | 29 |
| 2014 August | 47 | 2 | 49 |
| 2014 July | 26 | 6 | 32 |
| 2014 June | 27 | 2 | 29 |
| 2014 May | 18 | 2 | 20 |
| 2014 April | 14 | 3 | 17 |
| 2014 March | 20 | 1 | 21 |
| 2014 February | 16 | 6 | 22 |
| 2014 January | 15 | 5 | 20 |
| 2013 December | 19 | 2 | 21 |
| 2013 November | 22 | 3 | 25 |
| 2013 October | 24 | 7 | 31 |
| 2013 September | 37 | 5 | 42 |
| 2013 August | 28 | 4 | 32 |
| 2013 July | 22 | 2 | 24 |
Show all
