From the Research
Mechanism of Terson Syndrome
The mechanism of Terson syndrome is not fully understood, but several studies suggest that it is related to a sudden increase in intracranial pressure (ICP) due to subarachnoid hemorrhage (SAH) or severe brain injury 1, 2, 3. This increase in ICP is thought to cause intraocular hemorrhage, which can occur in the subretinal space, within the sensory retina, between the retina and the hyaloid membrane, and in the vitreous cavity 4.
Key Factors Contributing to Terson Syndrome
- Sudden increase in intracranial pressure (ICP) due to SAH or severe brain injury 1, 2, 3
- Higher Fisher and World Federation of Neurosurgical Societies (WFNS) scores are associated with a higher incidence of Terson syndrome 5
- Occurrence of seizures is also a predictor of Terson syndrome 5
- Intraocular hemorrhage can occur bilaterally in some cases 3
Pathophysiology of Terson Syndrome
- The exact pathophysiology of Terson syndrome is not fully understood, but it is thought to involve the sudden increase in ICP causing a rupture of the retinal or choroidal vessels, leading to intraocular hemorrhage 1, 2
- The hemorrhage can hydrodissect the internal limiting membrane from the underlying neurosensory retina, leading to retinal folds or fibrotic lines 4
Clinical Implications
- Terson syndrome is a common complication in patients with SAH, affecting approximately one in five patients 5
- Early recognition and treatment of Terson syndrome are important to prevent visual impairment and associated secondary damage to the eye 2, 3
- Pars plana vitrectomy may be necessary in some cases to treat Terson syndrome, especially if there is significant vitreous hemorrhage or retinal detachment 5, 4