Terson's Syndrome with Roth Spot-Resembling Features and Third Nerve Palsy without Radiologically Diagnosed...

Area of Science:

• Ophthalmology
• Neurology
• Neurosurgery

Background:

• Terson syndrome, characterized by intraocular hemorrhage, is typically associated with subarachnoid hemorrhage.
• Third nerve palsy (oculomotor nerve palsy) can result from various neurological insults, including aneurysms.

Observation:

• A patient presented with pupil-involving third nerve palsy and bilateral Terson syndrome with Roth spot-like retinal hemorrhages.
• The patient had no disturbance of consciousness or nuchal rigidity, with a Glasgow Coma Scale score of 15/15.

Findings:

• Cerebral CT angiography revealed a 5 mm aneurysm of the right posterior communicating artery.
• This case represents a novel association of Terson syndrome and third nerve palsy without subarachnoid hemorrhage or altered consciousness.

Implications:

• Ophthalmological findings can be crucial in the early diagnosis of life-threatening conditions like posterior communicating artery aneurysms.
• This case underscores the importance of a comprehensive neurological and ophthalmological evaluation in patients presenting with unusual combinations of symptoms.