Terson Syndrome in Patients with Aneurysmal Subarachnoid Hemorrhage: A 10-Year Single-Center Experience

BackgroundTerson syndrome (TS), an intraocular hemorrhage associated with aneurysmal subarachnoid hemorrhage (aSAH), occurs in up to 46% of all patients with subarachnoid hemorrhage. Despite its high incidence, TS is underrepresented in the literature, and patients with aSAH are sometimes not systematically evaluated for the presence of TS in clinical practice. This work aims to raise awareness of TS, reevaluate previous scientific findings, describe risk factors associated with the occurrence of TS, and present our local diagnostic and treatment concept.MethodsAll patients with aSAH treated at our institution between October 2010 and May 2020 were included in this retrospective study. The frequency of ophthalmological screening by indirect funduscopy, as well as the results, was investigated. In addition, the collection and statistical analysis of epidemiological and clinical data was performed using chi(2), Kruskal-Wallis, and analysis of variance testing; multivariate regression; and receiver operating characteristic analysis. The significance level was set at p < 0.05.ResultsA total of 617 patients were treated for aSAH in our institution. Of these, 367 patients (59.5%) were ophthalmologically examined for the presence of TS. The rate of TS in the examined patients was 21.3% (n = 78). Patients with TS had significantly higher Fisher and World Federation of Neurosurgical Societies (WFNS) scores (p < 0.0001). Regression analyses showed WFNS grade (p = 0.003) and the occurrence of seizures (p = 0.002) as independent predictors of TS, as did receiver operating characteristic analyses, which had a significant area under the curve of 0.66 for the combination of WFNS grade and seizures. For 12 (15.4%) patients, the TS had to be surgically treated by pars plana vitrectomy in a total of 14 eyes, which resulted in significant improvement of visual function in all patients: mean preoperative best-corrected visual acuity was 0.03 (+/- 0.08) versus 0.76 (+/- 0.21) postoperatively (p < 0.001).ConclusionsTS is a common complication in patients with aSAH, affecting approximately one in five patients. A higher WFNS grade and the occurrence of seizures are associated with TS; therefore, screening for TS should be performed in these patients.

Automated summary

Terson syndrome (TS) is a common complication in patients with aneurysmal subarachnoid hemorrhage (aSAH), with an incidence rate of up to 46%. This study aimed to raise awareness of TS, evaluate previous scientific findings, identify risk factors associated with TS occurrence, and present a local diagnostic and treatment concept. A retrospective study was conducted on 617 aSAH patients, of which 367 patients (59.5%) underwent ophthalmological examination. Regression and receiver operating characteristic analyses revealed that higher WFNS grade and the occurrence of seizures were independent predictors of TS. Surgical treatment resulted in significant improvement in visual function for patients with TS. Screening for TS should be performed in aSAH patients with higher WFNS grade and seizures.