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Terson syndrome in patients suffering from subarachnoid haemorrhage

Session Details

Session Title: Vitreoretinal Surgery I

Session Date/Time: Thursday 26/09/2013 | 11:00-12:30

Paper Time: 12:04

Venue: Hall 3 (Level 0)

First Author: L.Wagenfeld GERMANY

Co Author(s):    V. Knospe   P. Czorlich   J. Regelsberger   G. Richard     

Abstract Details

Purpose:

A coincidence of subarachnoid and vitreous haemorrhage referred to as Terson-Syndrome (TS) is a commonly underestimated condition in patients suffering from subarachnoid haemorrhage (SAH). In this interdisciplinary prospective study we evaluated the incidence of TS in a collective of SAH patients.

Setting:

Interdisciplinary prospective study in a university hospital.

Methods:

All SAH patients who were admitted to our clinic over a 24 months period were screened for TS following written consent by the patient or by the legal representative. 102 patients in total were included in this study. Ophthalmological examination was performed on day one and day 14 after written consent. Statistical analyses included t-test and chi-square tests to examine correlations between TS and gender, initial Glasgow Coma Scale (GCS) score, Hunt & Hess grade and initial intracranial pressure (ICP).

Results:

The incidence of TS was 19.6 % (20/102) with a predominance among female patients (16/66; male patients 4/36). The initial GCS in patients with TS was 9.0 ± 1.3, whereas patients without TS presented with an initial GCS of 13.4 ± 0.4 (P<0.001). Similar results were found for the Hunt & Hess grade (3.60 ± 0.3 in patients with TS vs. 2.02 ± 0.12 for patients without TS; P<0.001). Initial ICP was higher in patients with TS (9.97 ± 3.2 mmHg with TS vs. 4.51 ± 1.1 mmHg without TS; P=0.044). All patients in whom TS was diagnosed required ICP-monitoring and/or external ventricular drainage and intensified ICU management compared to the group without TS. To date 5 patients with TS were vitrectomized for non-resorbing vitreous haemorrhage. Three of these patients also had sub-ILM haemorrhage and ILM-peeling and lavage of the sub-ILM blood was performed. Final visual acuity was 20/25 or better in all eyes.

Conclusions:

Terson Syndrome may be present in about 20% of all SAH patients and may lead to temporary functional blindness. Functional results of vitrectomy for TS are good even if the treatment is postponed for several months until adequate recovery from SAH is achieved. Further efforts will focus on alternative techniques for the diagnosis of TS that circumvent the necessity of drug-induced pupil dilatation which is undesirable in ventilated ICU-patients. Ultrasound or visual evoked potentials seem to be promising tools and are currently being evaluated.

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