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[Clinical analysis of vitreous hemorrhage combined with ruptured aneurysm]
Abstract:
Eight cases of vitreous hemorrhage with ruptured intracranial aneurysm (Terson's syndrome) were experienced in our clinic from April, 1978 to April, 1983. They consisted of five males and three famales between 45 and 69 years old. All cases had unconscious attacks and three of them experienced repeated episodes of subarachnoid hemorrhage within 24 hours. CT scan, performed 24 hours within the attack, revealed remarkable high density areas at prepontine and suprasellar cisterns, interhemispheric and sylvian fissures. Ruptured aneurysms, confirmed by cerebral angiography and operative findings, were three anterior communicating artery aneurysms, three internal cerebral artery aneurysms, one middle cerebral artery aneurysm and one anterior cerebral artery aneurysm. We performed radical operation for the ruptured aneurysm, six cases at acute atage, one at 11 days and one at 18 days after the attack. Postoperative courses were all good. Five cases had bilateral vitreous hemorrhages and three had unilateral ones. At first they were treated conservatively. Visual acuity of six cases, 13 eyes improved gradually, but three cases, four eyes did not improve after four or five months after the attack. So we let ophthalmologist to perform vitrectomy, which showed effective results. Vitreous hemorrhage following a ruptured intracranial aneurysm is not a so rare complication than has been assumed and also its prognosis is not so poor. In most cases vitreous hemorrhage following a ruptured intracranial aneurysm should be treated conservatively, but in selected cases effective results would be given by vitrectomy.
Insights
Terson's syndrome, characterized by vitreous hemorrhage and ruptured intracranial aneurysms, is a significant neurosurgical complication. Early diagnosis and appropriate management, including potential vitrectomy, can lead to favorable visual outcomes.
Area of Science:
- Neurosurgery
- Ophthalmology
- Neurology
Background:
- Terson's syndrome, a rare complication of ruptured intracranial aneurysms, presents with vitreous hemorrhage.
- This condition can lead to significant visual impairment if not managed effectively.
Purpose of the Study:
- To analyze the clinical characteristics, management, and outcomes of patients with Terson's syndrome.
- To evaluate the efficacy of conservative treatment versus surgical intervention, including vitrectomy, for visual recovery.
Main Methods:
- Retrospective review of eight patients diagnosed with Terson's syndrome between 1978 and 1983.
- Analysis of clinical data, neuroimaging (CT scans), cerebral angiography, surgical interventions, and ophthalmological assessments.
Main Results:
- Five male and three female patients aged 45-69 experienced Terson's syndrome.
- Common aneurysm locations included anterior communicating artery, internal cerebral artery, middle cerebral artery, and anterior cerebral artery.
- Conservative management improved vision in most cases, but vitrectomy was effective for persistent visual loss.
Conclusions:
- Terson's syndrome is a more frequent complication of ruptured intracranial aneurysms than previously thought.
- While conservative treatment is often sufficient, vitrectomy offers a valuable therapeutic option for selected cases with poor visual prognosis.
- Prompt diagnosis and multidisciplinary management are crucial for optimizing patient outcomes.