Incidence and relative factors of Terson syndrome in patients with aneurysmal subarachnoid hemorrhage

Abstract

To investigate the incidence and relative factors of Terson syndrome in patients with aneurysmal subarachnoid hemorrhage (SAH). A prospective case series study was conducted in 202 eyes of 101 patients with aneurysmal subarachnoid hemorrhage from November 2009 to May 2010. Fundus examination and color fundus photograph under mydriasis were carried out on every patient diagnosed as Terson syndrome with initial direct ophthalmoscopy after their general state was stable. The incidence of Terson syndrome was analyzed and correlated with gender, consciousness state, Glasgow Coma Scale score (GCS) and Hunt-Hess grade, anatomical locations of the ruptured aneurysms, mortality rate. Fifteen (14.8%) Terson syndrome patients were diagnosed in a total of 101 aneurysmal subarachnoid hemorrhage patients. Analysis of our data revealed no statistically significant difference between men and women in regard to the incidence of Terson syndrome (χ(2) = 0.615, P > 0.05). A significant relationship was observed between consciousness state (χ(2) = 17.503, P < 0.05), GCS score (χ(2) = 7.673, P < 0.05), Hunt-Hess grade (χ(2) = 9.987, P < 0.05) and the incidence of Terson syndrome. A higher frequency of Terson syndrome was demonstrated in patients with consciousness disturbance, lower GCS score and higher Hunt-Hess grade. However, no correlation was found between localization of the ruptured aneurysm (χ(2) = 0.000, P > 0.05), mortality rate and the occurrence of Terson syndrome. One case required surgical treatment during follow-up. A higher frequency of Terson syndrome was observed in patients with aneurysmal subarachnoid hemorrhage, which had association with clinical conditions significantly. Therefore, the SAH patients with consciousness disturbance, lower GCS score and higher Hunt-Hess grade should be paid attention to ophthalmic conditions and performed fundus examination. The occurrence of Terson syndrome needs to be further explored whether to determine the prognosis in SAH patients. Terson hemorrhage absorbed spontaneously in most patients and required surgical intervention in very few patients.