[Terson syndrome: a frequently missed ophthalmologic complication in subarachnoid hemorrhage]

The syndrome of intra-vitreous bleeding in association with subarachnoid hemorrhage (SAH) was first described by the French ophthalmologist Albert Terson. In the last 10 years, 31 articles describing 202 cases of Terson's syndrome (TS) were published. Only 3 out of the 31 were printed in non-ophthalmological journals. The findings of our prospective study underline the fact that too little attention is paid to TS in the early treatment of patients with SAH. Between 1/95 and 8/97, 89 patients with spontaneous SAH (7% of all admissions) were transferred to our hospital for post acute phase rehabilitation. Out of these, 13 patients (19 eyes) could be diagnosed with TS. This corresponds to an incidence of 14.6% of all patients with SAH (previous studies: 2-27%). However, only one patient had been correctly diagnosed with TS in the referring clinic. Early recognition of TS is of high importance since diminuation of visual acuity even to functional blindness, complicated in the bilateral case, can hamper the rehabilitative process considerably. Moreover, complications can lead to significant and irreversible damage, i.e. proliferative vitreo-retinopathy (PVR), retinal breaks, traction amotio, and cataract. Suspicion of TS is raised in either cooperative patients complaining of compromised visual acuity or in patients where funduscopy shows vitreous opacity. According to our results, visual evoked potentials (VEP) have only a limited role in diagnosis because of their low sensitivity. Not infrequently, however, VEP may point to accompanying optic nerve atrophy, thereby suggesting conservative treatment. Absolute indications for surgical interventions are PVR and its sequelae; relative indications are subjective visual impairment, impediment of rehabilitation, or lack of spontaneous resorption of the hemorrhage. The surgical procedure of choice is the pars plana vitrectomy (PPV). Rare complications of this operation are retinal damage, endophthalmitis, and reoccurrence of hemorrhage.