34 Clinical Review of 20 Cases of Terson s Syndrome Takashi SUGAWARA, M.D., Yoshio TAKASATO, M.D., Hiroyuki MASAOKA, M.D., Yoshihisa OHTA, M.D., Takanori HAYAKAWA, M.D., Hiroshi YATSUSHIGE, M.D., Shogo IMAE, M.D., Takahiro YAMAMOTO, M.D., and Maki MUKAWA, M.D. Department of Neurosurgery, National Hospital Organization, Disaster Medical Center, Tokyo, Japan Summary: Generally vitreous hemorrhage (VH) is detected in 2.2% to 13% of subarachnoid hemorrhage (SAH) patients. VH with SAH (Terson s syndrome) is known to occur frequently in patients with severe SAH or re-ruptured aneurysms. We retrospectively analyzed 20 patients diagnosed with Terson s syndrome out of a total of 881 patients treated for SAH in our department from July 1995 to October 2004. Our study group comprised 15 male and 5 female patients ranging in age from 38 to 77 years (mean 51.2 years). Each patient was classified in Hunt & Kosnik (H&K) grades on admission. One patient was classified in Grade 2, 3 patients in Grade 3, 7 patients in Grade 4 and 9 patients in Grade 5. Each patient was further classified in a Fisher group: 1 patient was in Group 2, 9 patients in Group 3, and 10 patients in Group 4. Regarding the aneurysmal location, 4 cases had ICA aneurysms, 6 had AcomA aneurysms, 4 had MCA aneurysms, 4 had VA or BA aneurysms, and 2 had ACA aneurysms. Re-rupture of aneurysm occurred in 4 cases. Two patients underwent external ventricular drainage because of acute hydrocephalus immediately after CT on admission. Seventeen aneurysms were treated by surgical neck clipping, and 3 aneurysms were treated by intraaneurysmal coil embolization as the final treatment. Seven patients underwent external decompression because of severe brain swelling, and 6 patients underwent V-P shunt for chronic hydrocephalus. Symptomatic vasospasm occurred in 1 case. Glasgow Outcome Scale (GOS) at discharge showed that 8 patients were GR, 10 were MD, and 2 were SD. VH occurred in only 1 patient on the contralateral side to the ruptured aneurysm among those who had obvious hemilateral VH. Vitrectomy was performed for the 17 VH of 10 patients, and the duration from VH onset to treatment was 8 24 weeks (mean 16.4 weeks). Conservative therapy was done for 15 VH of 10 patients, and the followup duration was 12 102 weeks (mean 27.0 weeks). Comparing these 20 VH patients with 311 favorable-outcome (GR or MD) patients who were not considered to have VH, H&K grade or Fisher group scales were significantly higher in VH patients. No significant difference existed between the groups with regard to the number of ruptures or the location of the ruptured aneurysms. Key words: Terson s syndrome subarachnoid hemorrhage vitreous hemorrhage vitrectomy cerebral aneurysm Surg Cereb Stroke (Jpn) 34: 294 298, 2006
χ Table 1 Clinical features in 20 patients of Terson s syndrome No Age Sex Number of rupture Location of AN H&K grade WFNS grade Fisher group GOS 1 49 F 1 VA 4 4 3 GR 2 64 M 1 AcomA 5 5 4 GR 3 50 M 1 AcomA 5 5 3 GR 4 49 M 1 AcomA 4 5 3 MD 5 42 F 1 AcomA 4 5 4 MD 6 60 M 1 MCA 4 4 4 MD 7 60 F 2 AcomA 5 5 3 MD 8 38 M 1 ACA 5 5 4 GR 9 53 M 2 MCA 5 5 3 SD 10 41 M 1 ICA 3 3 3 MD 11 50 M 1 ICA 2 1 2 GR 12 77 F 1 AcomA 4 5 4 SD 13 45 M 1 VA 3 4 3 MD 14 49 M 1 ICA 4 4 3 MD 15 51 M 1 MCA 5 5 4 GR 16 50 F 1 VA 4 5 3 GR 17 44 M 2 VA 5 5 4 MD 18 59 M 2 ACA 5 5 4 MD 19 43 M 1 ICA 5 4 4 MD 20 49 M 1 MCA 3 4 4 GR
Table 2 Treatment of vitreous hemorrhage No Aneurysm side VH side Treatment side Time to treatment Follow up duration 1 L bil. RL - 25M2W 2 Mid bil. RL L L: 4M R: blindness (*) 3 Mid bil. RL R L R: 3M2W, L: 4M 4 Mid R - R: (**) 5 R bil. RL - 6M 6 R bil. RL R L R 2M, L: 3M 7 R bil. RL - 8M 8 L bil. RL R L R: 2M, L: 2M1W 9 R bil. RL - 6M 10 L R - 21M 11 R R R R: 6M 12 L bil. RL R L R: 5M, L: 5M3W 13 R bil. RL R L R: 3M, L: 3M1W 14 R bil. RL - 14M 15 R R - 3M 16 L bil. RL R L R: 3M, L: 13M 17 L L - 10M 18 R bil. RL R L R: 2M1W, L: 5M3W 19 L bil. RL L L: 2M R: 18M (***) 20 L L - 8M Abbreviation: bilbilateral, Lleft, Mmonth, Midmiddle, Rright, Wweek * caused by uveitis, ** could not follow up, *** under follow up
Fig. 1 Hunt & Kosnik Grade on admission. Fig. 3 Location of the aneurysm. Fig. 2 Fisher group on admission.
Acta Ophthalmol (Copenh) et al [ ( ) ( )] No Shinkei Geka et al J Neurosurg J Neurol Neurosurg Psychiatry et al J Neurosurg et al[ ] No Shinkei Geka J Neurosurg