IS Case 561: Terson's Syndrome on CT
Imaging Sciences URMC 2010
Publication Date: 2011-11-16
History
Patient is a 45-year-old male found unresponsive and transferred from another hospital after a CT scan showed intracerebral hemorrhage.
Findings
CT scan of the head without contrast showed an intraparenchymal hemorrhage with intraventricular extension. Additionally, there was an asymmetrically hyperdense, crescentic appearance of the left posterior globe.
Diagnosis
Terson's Syndrome on CT
Discussion
Terson syndrome is the ophthalmologic finding of vitreous or retinal hemorrhage in the setting of subarachnoid hemorrhage and elevated intracranial pressure. Sharp increases in intracranial pressure due to bleeding causes transmitted pressure through the optic nerve, compressing the venous plexus at the nerve head causing retinal venous hypertension and subsequently rupture. Contrary to initial belief, the blood is ocular in origin rather than blood from the intracranial hemorrhage communicating somehow with the eye via a pressure gradient.
Terson syndrome is a poor prognostic factor in patients with subarachnoid hemorrhage, as these patients have a 4.8 fold excess risk of death. 13% of patients presenting with SAH are found estimated to have concurrent retinal or vitreous hemorrhage.
Findings on CT of Terson syndrome include a hyperdense, crescentic or nodular pattern along the retina during the first few days of the subarachnoid hemorrhage.
References
- Swallow CE, Tsuruda JS, Digre KB, et al. Terson syndrome: CT evaluation in 12 patients. AJNR Am J Neuroradiol. 1998 Apr;19(4):743-7. PMID: 9576666
- McCarron MO, Alberts MJ, McCarron P. A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry. 2004 Mar;75(3):491-3. PMID: 14966173
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