Terson Syndrome Before Induction Chemotherapy for Acute Lymphoblastic Leukemia

Area of Science:

• Pediatric Hematology Oncology
• Neuro-Ophthalmology

Background:

• Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
• Intracranial hemorrhage (ICH) and intraocular hemorrhage (IOH) are serious complications.
• Terson syndrome links ICH with IOH, typically seen in adults.

Observation:

• A previously healthy 2-year-old female infant with pancytopenia was diagnosed with ALL.
• Prior to leukemia treatment, she exhibited symptoms of increased intracranial pressure.
• Head imaging confirmed left parietal hemorrhage and right vitreous hemorrhage.

Findings:

• The patient presented with both intracranial and intraocular hemorrhages.
• This presentation is consistent with Terson syndrome.
• Ocular manifestations in leukemia are uncommon at diagnosis and usually asymptomatic.

Implications:

• This case suggests Terson syndrome can occur in pediatric patients with acute lymphoblastic leukemia.
• Early recognition of neurological and ophthalmological symptoms is crucial in pediatric leukemia.
• Further research is needed to understand the incidence and management of Terson syndrome in pediatric leukemia.