Abstract
IntroductionIntraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as Terson's syndrome and is an underestimated but common pathology. We therefore designed a prospective single-blinded study to evaluate the validity of ocular ultrasound compared to the gold standard indirect funduscopy in the diagnosis of Terson's syndrome.Material and MethodsFifty-two patients (104 eyes in total) suffering from aneurysmal subarachnoid hemorrhage were enrolled in this study. Two investigators independently performed a single-blinded ocular ultrasound using a standard intensive care ultrasound system to detect an intraocular hemorrhage. Indirect funduscopy following iatrogenic mydriasis served as the gold standard for confirmation or exclusion of an intraocular hemorrhage. Statistical analyses were performed to evaluate the sensitivity and specificity, positive and negative predictive values of the method as well as the learning curve of ocular ultrasound.ResultsIndirect funduscopy detected Terson's syndrome in 11 of 52 (21.2%) respectively in 21 of 104 (20.2%) eyes in patients suffering from subarachnoid hemorrhage. Sensitivity and specificity increased with the number of ocular ultrasound examinations for both investigators, reaching 81.8% and 100% respectively. Positive and negative predictive values were different for both investigators (63.6% vs. 100% positive and 100% vs. 95.7% negative) but were both correlated to the amount of intraocular hemorrhage. A low Glasgow Coma scale (p = 0.015) and high Hunt & Hess grade (p = 0.003) was associated with a higher rate of Terson's syndrome.ConclusionsOcular ultrasound using standard ultrasound equipment has been confirmed as a reliable, easy-to-handle bedside screening tool for detecting Terson's syndrome. Nevertheless funduscopy remains the gold standard to detect Terson's syndrome.
Highlights
Intraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as Terson’s syndrome and is an underestimated but common pathology
Positive and negative predictive values were different for both investigators (63.6% vs. 100% positive and 100% vs. 95.7% negative) but were both correlated to the amount of intraocular hemorrhage
Aim of this study was to scrutinize if ocular ultrasound may be established as a standard diagnostic tool in non-specialized intensive care and neurological rehabilitation units to screen for ocular bleedings and preventing worse clinical outcome with visual impairment
Summary
Intraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as Terson’s syndrome and is an underestimated but common pathology. We designed a prospective single-blinded study to evaluate the validity of ocular ultrasound compared to the gold standard indirect funduscopy in the diagnosis of Terson’s syndrome. As unilateral and bilateral pupillary dilation is a sign of sudden increase of intracranial pressure (ICP) [12,13] requiring urgent diagnostic and therapeutic considerations, funduscopy is not a feasible method for critically ill SAH patients. In this context ocular ultrasound presents as a wellknown but less utilized diagnostic tool available for all clinics without specialized ophthalmological service [7, 14, 15]. Aim of this study was to scrutinize if ocular ultrasound may be established as a standard diagnostic tool in non-specialized intensive care and neurological rehabilitation units to screen for ocular bleedings and preventing worse clinical outcome with visual impairment
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