Bilateral retinal hemorrhage after endoscopic third ventriculostomy: iatrogenic Terson syndrome

Case report

View More View Less
  • 1 Departments of Neurosurgery and
  • 2 Ophthalmology, University Medical Centre Groningen, The Netherlands
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00
Print or Print + Online

A serious ophthalmological complication of an endoscopic third ventriculostomy that created an iatrogenic Terson syndrome is described. A patient with an obstructive hydrocephalus was treated endoscopically, but due to the inadvertent use of a pressure bag during rinsing, in combination with a blocked outflow channel, a steep rise in intracranial pressure occurred. Postoperatively the patient experienced disturbed vision caused by bilateral retinal hemorrhages, and an iatrogenic Terson syndrome was diagnosed. The pathogenesis of Terson syndrome is discussed based on this illustrative case.

Abbreviations used in this paper: ETV = endoscopic third ventriculostomy; ICP = intracranial pressure.

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $505.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $600.00

Contributor Notes

Address correspondence to: Eelco W. Hoving, M.D., Ph.D., Department of Neurosurgery, University Medical Centre Groningen, P.O. Box 30.001, 9700RB Groningen, The Netherlands. email: e.w.hoving@nchir.umcg.nl.
  • 1

    Ballantyne AJ: The ocular manifestations of spontaneous subarachnoid haemorrhage. Br J Ophthalmol 27:383414, 1943

  • 2

    Beems T, & Grotenhuis JA: Long-term complications and definition of failure of neuroendoscopic procedures. Childs Nerv Syst 20:868877, 2004

    • Search Google Scholar
    • Export Citation
  • 3

    Cinalli G, , Spennato P, , Ruggiero C, , Alberti F, , Trischitta V, & Buonocore MC, : Complications following endoscopic intracranial procedures in children. Childs Nerv Syst 23:633644, 2007

    • Search Google Scholar
    • Export Citation
  • 4

    Cipri S, , Gangemi A, , Cafarelli F, , Messina G, , Iacopino P, & Al Sayyad S, : Neuroendoscopic management of hydrocephalus secondary to midline and pineal lesions. J Neurosurg Sci 49:97106, 2005

    • Search Google Scholar
    • Export Citation
  • 5

    De Terson A: l'hémorrhagie dans le corps vitré au cours de l'hemorrhagie cérébrale. Clin Ophthalmol 6:309312, 1900

  • 6

    Feng H, , Huang G, , Liao X, , Fu K, , Tan H, & Pu H, : Endoscopic third ventriculostomy in the management of obstructive hydrocephalus: an outcome analysis. J Neurosurg 100:626633, 2004

    • Search Google Scholar
    • Export Citation
  • 7

    Frizzell RT, , Kuhn R, , Quinn C, & Fisher WS III: Screening for ocular hemorrhages in patients with ruptured cerebral aneurysms: a prospective study of 99 patients. Neurosurgery 41:529533, 1997

    • Search Google Scholar
    • Export Citation
  • 8

    Garfinkle AM, , Danys IR, , Nicolle DA, , Colohan AR, & Brem S: Terson's syndrome: a reversible cause of blindness following subarachnoid hemorrhage. J Neurosurg 76:766771, 1992

    • Search Google Scholar
    • Export Citation
  • 9

    Hedges TR, , Weinstein JD, & Crystle CD: Orbital vascular response to acutely increased intracranial pressure in the rhesus monkey. Arch Ophthalmol 71:226237, 1964

    • Search Google Scholar
    • Export Citation
  • 10

    Iwase T, & Tanaka N: Bilateral subretinal haemorrhage with Terson's syndrome. Graefes Arch Clin Exp Ophthalmol 244:507509, 2006

  • 11

    Kalmar AF, , Van aken J, , Caemaert J, , Mortier EP, & Struys MM: Value of Cushing reflex as warning sign for brain ischaemia during neurendoscopy. Br J Anaesth 94:791799, 2005

    • Search Google Scholar
    • Export Citation
  • 12

    Khan SG, & Frenkel M: Intravitreal hemorrhage associated with rapid increase in the intracranial pressure (Terson's syndrome). Am J Ophthalmol 80:3743, 1975

    • Search Google Scholar
    • Export Citation
  • 13

    Manschot WA: Subarachnoid hemorrhage; intraocular symptoms and their pathogenesis. Am J Ophthalmol 38:501505, 1954

  • 14

    McCarron MO, , Alberts MJ, & McCarron P: A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 75:491493, 2004

    • Search Google Scholar
    • Export Citation
  • 15

    Medele RJ, , Stummer W, , Mueller AJ, , Steiger HJ, & Reulen HJ: Terson's syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acute raised intracranial pressure. J Neurosurg 88:851855, 1998

    • Search Google Scholar
    • Export Citation
  • 16

    Miller AJ, & Cuttino JT: On the mechanism of production of massive preretinal hemorrhage following rupture of a congenital medial defect intracranial aneurysm. Am J Ophthalmol 31:1534, 1948

    • Search Google Scholar
    • Export Citation
  • 17

    Muller PJ, & Deck JH: Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension. J Neurosurg 41:160166, 1974

    • Search Google Scholar
    • Export Citation
  • 18

    Naseri A, , Blumenkranz MS, & Horton JC: Terson's syndrome following epidural saline injection. Neurology 57:364, 2001

  • 19

    Navarro R, , Gil-Parra R, , Reitman AJ, , Olavarria G, , Grant JA, & Tomita T: Endoscopic third ventriculostomy in children: early and late complications and their avoidance. Childs Nerv Syst 22:506513, 2006

    • Search Google Scholar
    • Export Citation
  • 20

    Ness T, , Janknecht P, & Berghem C: Frequency of ocular haemorrhages in patients with subarachnoid hemorrhage. Graefes Arch Clin Exp Ophthalmol 243:859862, 2005

    • Search Google Scholar
    • Export Citation
  • 21

    O'Brien DF, , Hayhurst C, , Pizer B, & Malucci CL: Outcomes in patients undergoing single-trajecory endoscopic third ventriculostomy and endoscopic biopsy for midline tumors presenting with obstructive hydrocephalus. J Neurosurg 105:3 Suppl 219226, 2006

    • Search Google Scholar
    • Export Citation
  • 22

    Peretta P, , Ragazzi P, , Galarza M, , Genitori L, , Giordano F, & Mussa F, : Complications and pitfalls of neuroendoscopic surgery in children. J Neurosurg 105:3 Suppl 187193, 2006

    • Search Google Scholar
    • Export Citation
  • 23

    Pfausler B, , Belcl R, , Metzler R, , Mohsenipour J, & Schmutzhard E: Terson's syndrome in spontaneous subarachnoid hemorrhage: a prospective study in 60 consecutive patients. J Neurosurg 85:392394, 1996

    • Search Google Scholar
    • Export Citation
  • 24

    Prabhakar H, , Bithal PK, , Suri A, , Rath GP, & Dash HH: Intracranial pressure changes during Valsalva manoeuvre in patients undergoing a neuroendoscopic procedure. Minim Invasive Neurosurg 50:98101, 2007

    • Search Google Scholar
    • Export Citation
  • 25

    Schultz PN, , Sobol WM, & Weingeist TA: Long-term visual outcome in Terson syndrome. Ophthalmology 98:18141819, 1991

  • 26

    Stiebel-Kalish H, , Turtel LS, & Kupersmith MJ: The natural history of nontraumatic subarachnoid hemorrhage-related intraocular hemorrhages. Retina 24:3640, 2004

    • Search Google Scholar
    • Export Citation
  • 27

    Walsh FB, & Hedges TR Jr: Optic nerve sheath hemorrhage. Am J Ophthalmol 34:509527, 1951

Metrics

All Time Past Year Past 30 Days
Abstract Views 236 110 5
Full Text Views 139 8 0
PDF Downloads 74 6 0
EPUB Downloads 0 0 0