TERSON SYNDROM : about three cases reports

Transcription

1 TERSON SYNDROM : about three cases reports Poster No.: C-2544 Congress: ECR 2012 Type: Scientific Exhibit Authors: Z. Jamaleddine, M. M. Cherkaoui, A. Elquessar; Rabat/MA Keywords: Eyes, Head and neck, CT, MR-Angiography, Ultrasound, Embolisation, Surgery, Hemorrhage DOI: /ecr2012/C-2544 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 22

2 Purpose Terson's syndrom is the association of vitreous or retinal haemorrhage with subarachnoid haemorrhage (SAH), mentioned for the first time in In adults, some form of intraocular hemorrhage has been reported to accompany the cerebrovascular incident in 18% to 41 % of cases. In children, the rate may reach 70%. However, vitreous hemorrhage, whichare the true Terson syndrome are observed in less than 10% of cases of ruptured aneurysm intracranial. The bilaterality represents between 14% and 60% of cases. Ruptured aneurysm and AVM is the most common cause, traumatic causes are very rare. Although the diagnosis is typically made fundoscopically. The objective of our study is to describe, the clinical, radiological characteristics of this syndrome and the therapeutic indications through three cases listed in our formation. Methods and Materials Retrospective study of three cases (man of 28 and two womens of 37 and 51 years old) hospitalised for subarachnoid haemorrhage (SAH) and secondary complicated by intravitreous haemorrhage (Terson syndrome). Imaging exploration of SAH based on Computer tomography 16 bars, MRI 1.5 Tesla and cerebral angiography, and ocular ultrasonography for the examination of intravitreous haemorrhage. All patients were treated by embolisation for the etiology of SAH : two aneurysms and one AVM. Results Case 1: A 37 years old female admitted for left hemiplegia. SAH secondary to AVM was diagnosed by CT scan and MRI (Figure1). The AVM was treated by embolisations (Figure 2, 3). She compleined of loss of vision in a right eye three months later. Page 2 of 22

3 Right ocular ultrasound showed a vitreous hemorrhage withowt retinal detachment (Figure 4). Vitrectomy was proposed and visuel acuity improved immediately. Fig. 1: MRI in axial T2 and coronal Flair: right temporoparietal AVM References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Fig. 2: Arteriography showing a temporoparietal AVM alimented by anterior cerebral artery and posterior choroidal artery. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Page 3 of 22

4 Fig. 3: AVM control by angiography showed a total recovery after radiosurgery and several sessions for embolisation. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Page 4 of 22

5 Fig. 4: Right ocular ultrasound: vitreous hemorrhage without retinal detachment. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Case 2: A 28 years old male presented with headache, vomiting and VI paralysis. SAH was diagnosed on a CT head scan. Angio-MRI revealed a single aneurysm at the left vertebral artery (Figure 5). The aneurysm was treated by embolisation (Figure 6). Blindness of left eye was showed ten days later. Ocular ultrasonography confirmed a vitreous hemorrhage (Figure 7) and a diagnosis of Terson's syndrome was made. Vitrectomy was proposed and visuel acuity improved after surgery. Page 5 of 22

6 Fig. 5: Sagittal T1 and axial T2 with Angio-MRI in 3D: SAH secondary to an aneurysm at the left vertebral artery. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Page 6 of 22

7 Fig. 6: Arteriography before and after embolisation of the left vertebral artery. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Page 7 of 22

8 Fig. 7: Left ocular ultrasound: vitreous hemorrhage. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Case 3: Women of 51 years treated for left PICA aneurysm revealed after intraventricular haemorrhage (Figure 8, 9). The aneurysm was embolised ( Figure 10). She presented impairement of right visuel acuiety one week after, an ocular ultrasonography showed a vitreous hemorrhage ( Figure 11). Patient is waiting for surgery. Page 8 of 22

9 Fig. 8: Axial CT scan: intraventricular haemorrhage. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Page 9 of 22

10 Fig. 9: Angio-MRI in 3D: left PICA aneurysm. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Page 10 of 22

11 Fig. 10: Arteriography before and after embolisation of the PICA aneurysm. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Page 11 of 22

12 Fig. 11: Right ocular ultrasound showed a vitreous hemorrhage. References: Z. Jamaleddine; Cheikh Zaid Hospital, Rabat, MOROCCO Images for this section: Page 12 of 22

13 Fig. 1: MRI in axial T2 and coronal Flair: right temporoparietal AVM Fig. 2: Arteriography showing a temporoparietal AVM alimented by anterior cerebral artery and posterior choroidal artery. Page 13 of 22

14 Fig. 3: AVM control by angiography showed a total recovery after radiosurgery and several sessions for embolisation. Page 14 of 22

15 Fig. 4: Right ocular ultrasound: vitreous hemorrhage without retinal detachment. Page 15 of 22

16 Fig. 5: Sagittal T1 and axial T2 with Angio-MRI in 3D: SAH secondary to an aneurysm at the left vertebral artery. Page 16 of 22

17 Fig. 6: Arteriography before and after embolisation of the left vertebral artery. Page 17 of 22

18 Fig. 7: Left ocular ultrasound: vitreous hemorrhage. Page 18 of 22

19 Fig. 8: Axial CT scan: intraventricular haemorrhage. Page 19 of 22

20 Fig. 9: Angio-MRI in 3D: left PICA aneurysm. Page 20 of 22

21 Fig. 10: Arteriography before and after embolisation of the PICA aneurysm. Fig. 11: Right ocular ultrasound showed a vitreous hemorrhage. Page 21 of 22

22 Conclusion The significant decrease in visual acuity is the most commun symptom in Terson syndrom. Ultrasound allows the search for retinal detachment intravitreal hemorrhage is often dense, mobile, abundant, with a posterior vitreous detachment usually total. The mobility is a feature of Terson syndrome. Vitrectomy has been shown to be extremely effective in clearing the vitreous hemorrhage and should be considered in patients with intraocular bilateral hemorrhage or if the vitreous hemorrhage does not show signs of spontaneous resorption after 1 to 3 month. It appears necessary to examine visual acuity in case of subarachnoid haemorrhage for an early diagnosis and the better treatment of this rare syndrom. References Takeshi Iwase, Nobushige Tanaka. Bilateral subretinal haemorrhage with Terson's syndrome. Graefe's Arch Clin Exp Ophthalmol. 2006, 244: Chiaki D. Gauntt, Richard G. Sherry and Chithra Kannan. Terson syndrome with bilateral optic nerve sheath hemorrhage. J Neuro-Ophthalmol. 2007, Vol 27, No 3: Ferenc Kuhn, Robert Morris, C. Douglas Whiterspoon, Viktoria Mester. Terson Syndrome: Results of vitrectomy and the significance of vitreous heamorrhage in patients with subarachnoid hemorrhage. Ophthalmology. 1998, Vol 105, No 3: D. Perennou, J. Pélissier, L. Beaufrère, E. Laurent, C. Bénaim, L. Belso, G. Dupeyron, P. Frérebeau. Baisse de l'acuité visuelle aprés hémorragie cérébromeningée :six cas de syndrome de Terson. Ann Réadaptation Med Phy. 2000, 43 : M.H. Errera, P.O. Barale, Y. Ounnoughene, M. Puech, J.A. Sahel. 25-Gauge transconjunctival vitrectomy in a case of bilateral epiretinal membrane associated with a Terson Syndrome. Journal Français d'ophtalmologie. 2009, 32: J. P. Berrod. Hémorragies non traumatiques du vitré. EMC d'ophtalmologie. 2006, A-26. Personal Information Page 22 of 22