Brain Neurorehabil.  2014 Sep;7(2):136-142. 10.12786/bn.2014.7.2.136.

Terson Syndrome after Subarachnoid Hemorrhage Occurred by Thrombolysis and Mechanical Thrombectomy to Treat Acute Ischemic Stroke: A Case Report

• Byun HY
• Jung H
• Choi HJ
• Lee JH
• Oh MK
• Yoon CH
• Shin H
• Lee ES

• KMID: 1797648
• DOI: http://doi.org/10.12786/bn.2014.7.2.136

Abstract

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.

Keyword

vitreous hemorrhage; stroke; subarachnoid hemorrhage

MeSH Terms

Aneurysm
Anterior Cerebral Artery
Cerebral Infarction
Hemorrhage
Humans
Middle Aged
Middle Cerebral Artery
Ophthalmology
Rupture
Stroke*
Subarachnoid Hemorrhage*
Subarachnoid Hemorrhage, Traumatic
Thrombectomy*
Treatment Outcome
Visual Acuity
Vitrectomy
Vitreous Hemorrhage

Figure

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  Fig. 1. Axial images of brain magnetic resonance imaging obtained at the emergency department visit. Note the acute infarction in right basal ganglia and periventricular white matter.

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  Fig. 2. MR angiography with Gadolinium demonstrates complete occlusion of right distal ICA, right MCA and right ACA.

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  Fig. 3. Axial images of brain computed tomography image taken immediately after the mechanical thrombolysis shows SAH with extravasated contrast media in right basal ganglia and periventricular white matter.

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  Fig. 4. Ten hours later, hemorrhage resolved and extravasated contrast media disappeared.

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  Fig. 5. (A) Funduscopic photograph shows vitreous hemorrhage (grade 4; dense vitreous hemorrhage with no red reflex) on right eye. (B) Funduscopic photograph shows resolved vitresous hemorrhage (grade 0; no blood present in vitreous and entire retina is visible) on right eye.

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