Terson syndrome

Terson syndrome refers to vitreous haemorrhage associated with subarachnoid haemorrhage, however some authors include retinal haemorrhage as well. The syndrome is a poor prognostic marker in patients with subarachnoid haemorrhage.

Terson syndrome has been reported to occur in 13-50% of patients with subarachnoid haemorrhage 1-3.  

In addition to clinical features of severe subarachnoid haemorrhage, such as headache and coma, patients present with varying degrees of vision loss 4. Fundoscopic examination is diagnostic, with patients having evidence of vitreous haemorrhage (and perhaps other intraocular hemorrhage) 1.

These clinical features usually manifest within the first hour of subarachnoid haemorrhage, but can also be delayed  by days, and even weeks, after subarachnoid haemorrhage 5,6.

Severe subarachnoid haemorrhage, as demonstrated by a low Glasgow coma scale, a high Hunt and Hess grade, and/or a high Fisher grade, have been found to be associated with a higher incidence of Terson syndrome 5.

In this setting, intraocular haemorrhage is thought to be a consequence of a sudden increase in intracranial pressure causing obstruction of the central retinal vein as well as retinal venous stasis, which in turn results in vitreous and intraretinal haemorrhages 2

A similar syndrome has been reported to occur with subdural haematomas, epidural haematomas, and traumatic brain injury, all cases postulated to be also due to increased intracranial pressure 1,5. Some authors also term these similar presentations under the banner of Terson syndrome 1,5

On CT evaluation, retinal nodularity and crescentic hyperdensity, relative to the vitreous humour, in the posterior globe in association with subarachnoid hemorrhage are highly suggestive of this diagnosis 7.

Although spontaneous regression of the haemorrhage is seen in up to half of all patients, the condition may require operative intervention with vitrectomy, particularly in the setting of bilateral vitreous haemorrhages 1,5. The neurological outcome and overall prognosis is worse in subarachnoid haemorrhage patients with Terson syndrome, compared to those without 1,3,5.

Although the condition is named after Albert Terson (1867-1935), a French ophthalmologist, who described it in 1900 3,8, the first case was actually described a few years earlier in 1881 by Moritz Litten (1845-1907), a German physician 3,9.

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Article information

rID: 11072
Section: Syndromes
Tag: eye
Synonyms or Alternate Spellings:
  • Terson's syndrome

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