UMEM Educational Pearls

Category: Neurology

Title: What is the cause of this patient's decreased vision?

Keywords: Terson syndrome, vitreous hemorrhage, intraocular hemorrhage, subarachnoid hemorrhage (PubMed Search)

Posted: 7/12/2017 by WanTsu Wendy Chang, MD
Click here to contact WanTsu Wendy Chang, MD

Question

50 YOF with acute onset of worst headache of life associated with nausea and vomiting. Patient is somnolent, will rouse to noxious stimuli and complains of a headache as well as decreased vision.

Answer

There is a vitreous hemorrhage of the left globe associated with subarachnoid hemorrhage (SAH), intraventricular hemorrhage, and diffuse cerebral edema on this non-contrast head CT.
This is also known as Terson syndrome, reported to occur in 15-30% of patients with SAH.
The mechanism by which this intraocular hemorrhage occurred is thought to be from a sudden increase in intracranial pressure causing obstruction of the central retinal vein.

References

Image courtesy of Dr. Nasir Siddiqui, Radiopaedia.org. From the case rID: 36469

Follow me on Twitter @EM_NCC