Vitreous Hemorrhage after Aneurismal Rupture: Terson Syndrome

Introduction Terson syndrome is described as an intraocular hemorrhage consequent to a spontaneous subarachnoid hemorrhage (SSAH). In the present article, we describe cases of patients who underwent neurosurgical treatment of ruptured cerebral aneurysmat our institution over a period of one year, and who were diagnosed with Terson syndrome. Methods The present study included patients with a diagnosis of SSAH by rupture of a cerebral aneurysm who underwent treatment in our neurosurgical service from December 2009 to December 2010. The patients were followed-up for a minimum of 20 months.We have also performed a literature review and compared the data with those available in the current literature. Results The present study included 34 patients, 18 (53%) of which underwent endovascular treatment, and 16 (47%) who underwent microsurgical clipping. In the sample, the mortality was 14.7% (5 patients), the same percentage of patients who were diagnosed with Terson Syndrome, which is an incidence of 14.7%. Regarding the ophthalmologic evaluation, all patients had vitreous hemorrhage detected by an ultrasound examination, which was unilateral in only two patients. Visual acuity improved in all patients, being incomplete in only one of them. Conclusion Terson syndrome is relatively common and is associated with higher mortality. With the existence of an effective treatment, it should be investigated in all patients with SSAH.

Williams syndrome: ophthalmological examination and review of systemic manifestations.

PURPOSE: To evaluate the frequency and severity of ophthalmic manifestations and associated diseases, as well as the epidemiological data in patients with Williams syndrome. METHODS: The authors prospectively studied 30 patients clinically diagnosed as having Williams syndrome as confirmed by the fluorescence in situ hybridization test. Patient history included gender, age, race, education level, previous illnesses, and surgeries. The ophthalmologic examination included best-corrected visual acuity, dynamic and static refraction, extraocular motility test, stereopsis test (Titmus and Lang), and direct and indirect funduscopy. RESULTS: Thirty patients were included in this study. The mean age was 14.5 ± 1.38 years (range: 7 to 26 years). Fifty percent of the patients were male and 50% were female. Among the children examined, 77% had a refractive error. Hyperopia and astigmatism were noted in 67% and 20% of the patients, respectively, and myopia in 7%. Only one case of amblyopia was noted. On external examination, 23% of children had epicanthus; via biomicroscopy, 3 children with stellate patterns of the irides were observed. Eleven patients (36.6%) had measurable strabismus, 9 (82%) had esotropia, and 2 (18%) had exotropia. Binocular vision was abnormal in 43% of patients. Diffuse arteriovenous tortuosity on funduscopy was observed in 27% of patients. CONCLUSIONS: Williams syndrome is rare and is associated with multiple phenotypes and diseases that are susceptible to treatment. Multidisciplinary clinical management is critical and, in some cases, surgical intervention is required.