ABSTRACT
Objetivo A síndrome de Terson (ST), também conhecida como hemorragia vítrea, é relatada em pacientes com hemorragia subaracnóide causada por um aneurisma rompido. Este estudo tem como objetivo avaliar a presença de hemorragia ocular nesses pacientes, buscando identificar aqueles que poderiam se beneficiar do tratamento específico para a recuperação do déficit visual. Métodos Estudo prospectivo de 53 pacientes com hemorragia subaracnóide espontânea (SSAH) por aneurisma rompido. Os pacientes foram avaliados quanto à hemorragia vítrea por fundoscopia indireta com 6 a 12 meses de seguimento. Resultados A idade dos pacientes variou de 17 a 79 anos (média de 45,9 ± 11,7); 39 pacientes eram do sexo feminino (73%) e 14 do sexo masculino (27%). Seis pacientes (11%) apresentaram ST e 83,3% apresentaram perda transitória de consciência durante a ictus. Conclusões Uma avaliação oftalmológica deve ser realizada rotineiramente em pacientes com hemorragia subaracnóide, especialmente naqueles com pior grau neurológico. Além disso, o prognóstico foi ruim em pacientes com ST.
Subject(s)
Humans , Male , Female , Aortic Rupture/diagnostic imaging , Subarachnoid Hemorrhage/diagnostic imaging , Vitreous Hemorrhage/diagnostic imaging , Retinal Hemorrhage/diagnostic imaging , Diagnostic Techniques, Ophthalmological , Aortic Rupture/mortality , Spinal Puncture/methods , Subarachnoid Hemorrhage/mortality , Vitrectomy/methods , Vitreous Hemorrhage/mortality , Retinal Hemorrhage/mortality , Cerebral Angiography/methods , Chi-Square Distribution , Prospective StudiesABSTRACT
Objective Terson syndrome (TS), also known as vitreous hemorrhage, is reported in patients with subarachnoid hemorrhage caused by a ruptured aneurysm. This study aims to evaluate the presence of ocular hemorrhage in such patients, trying to identify those who could benefit from the specific treatment for visual deficit recovery. Methods Prospective study of 53 patients with spontaneous subarachnoid hemorrhage (SSAH) due to ruptured aneurysm. The patients were evaluated for vitreous hemorrhage through indirect fundoscopy with 6 to 12 months of follow-up. Results The ages of the patients ranged from 17 to 79 years-old (mean age, 45.9 11.7); 39 patients were female (73%) and 14 were male (27%). Six patients (11%) presented TS, and 83.3% had a transient loss of consciousness during ictus. Conclusions An ophthalmologic evaluation must be routinely performed in subarachnoid hemorrhage patients, especially in those with worse neurological grade. Moreover, prognosis was bad in TS patients.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged , Aortic Rupture/complications , Subarachnoid Hemorrhage/etiology , Vitreous Hemorrhage/mortality , Vitreous Hemorrhage/diagnostic imaging , Aortic Rupture/mortality , Aortic Rupture/diagnostic imaging , Prognosis , Subarachnoid Hemorrhage/mortality , Subarachnoid Hemorrhage/diagnostic imaging , Chi-Square Distribution , Data Interpretation, Statistical , Diagnostic Techniques, OphthalmologicalABSTRACT
PURPOSE: To describe the first case of a combined sub-hyaloid and sub-internal limiting membrane macular hemorrhage after recreational laser exposure. METHODS: A 23-year-old patient presented with an acute loss of vision in his right eye (OD) immediately after a brief exposure to a laser beam at a music festival. Color photography, spectral-domain optical coherence tomography (SD-OCT), and multifocal electroretinogram (mfERG) were performed for diagnosis and follow-up. RESULTS: On presentation, visual acuity was 20/400 in the OD and 20/20 in the left eye. Posterior segment examination of his OD revealed a preretinal hemorrhage at the macula. SD-OCT images exposed a combined sub-hyaloid and sub-internal limiting membrane localization. Successful VPP with ILM peeling was carried out. Although sequential mfERG displayed almost complete restoration of the P1 amplitude 6 months posterior to VPP, SD-OCT demonstrated permanent damage to outer retinal layers. Final BCVA on OD was 20/30. CONCLUSION: The expanding and unregulated use of lasers in everyday life has created an increasing amount of cases of laser-induced retinopathy in recent years. Much more attention should be addressed in laser safety and awareness to prevent future ocular injuries. In acute phases of sub-hyaloid hemorrhages blocking direct visualization of the posterior pole, mfERG is a valuable tool to address initial macular pathology.
Subject(s)
Eye Injuries/etiology , Lasers/adverse effects , Retina/injuries , Retinal Hemorrhage/etiology , Vitreous Body/injuries , Vitreous Hemorrhage/etiology , Electroretinography , Eye Injuries/diagnostic imaging , Eye Injuries/surgery , Holidays , Humans , Male , Retinal Hemorrhage/diagnostic imaging , Retinal Hemorrhage/surgery , Tomography, Optical Coherence , Visual Acuity/physiology , Vitrectomy , Vitreous Hemorrhage/diagnostic imaging , Vitreous Hemorrhage/surgery , Young AdultABSTRACT
Terson's syndrome describes the concurrence of intracranial hemorrhage, vitreous hemorrhage and juxtapapillary subinternal limiting membrane and retinal hemorrhage. In most cases, the retinal and vitreous hemorrhage will clear spontaneously. Vitrectomy was indicated by persistent hemorrhage in two cases. Ultrasound was used to follow up the changes including premacular hemorrhage that appeared as a dome-shaped, smooth, mildly elevated, immobile membrane overlying the posterior pole. This membrane which represents the posterior hyaloid or internal limiting membrane is usually highly reflective due to the submembranous blood adherent to its posterior surface. Consequently, it may mimic localized detachment of the posterior pole. Differentiation from retinal detachment can usually be made by considering the history and other clinical findings. The clinical manifestations of Terson's syndrome, correlated well with the ultrasound findings until vitrectomy was done.