Presentations

Abstract

Introduction: Terson Syndrome (TS) is described as the presence of any intraocular hemorrhage in patients with intracranial hemorrhage or traumatic brain injury.

Case Information: We report on a 66-year-old female who presented to the ED with altered sensorium, nausea, vomiting, and headache. Initial CT head demonstrated presence of subarachnoid hemorrhage (SAH). Three days later, repeat CT head showed hyperdensity in the bilateral posterior globes suggestive of TS.

Discussion/Clinical Findings: In cases where TS is a concomitant process with subarachnoid hemorrhage (SAH), studies have shown an association with worse neurological outcomes and increased mortality. Therefore, presence of intraocular hemorrhage should be carefully examined for on imaging as it is an important prognostic factor. Unfortunately, given the acuity of patient conditions in these situations and often inability to communicate visual symptoms, ocular exams are frequently deferred5. Screening through ultrasound or head CT then becomes increasingly important. If left untreated, complications of TS include retinal damage and potentially irreversible vision loss.

Conclusion: Despite the relatively high incidence of TS in patients with SAH, it is likely an overall underdiagnosed condition. Awareness in radiologists to carefully examine the orbits and in medical professionals to obtain imaging or fundoscopic exams in the setting of head trauma or SAH should be increased to minimize diagnosis delay and chance of irreversible vision loss.