Kang Hae Min, Cho Jin Mo, Kim So Yeon, Choi Jeong Hoon
Department of Ophthalmology, Catholic Kwandong University, International St. Mary's Hospital, Incheon 22711, Republic of Korea.
Department of Neurosurgery, Catholic Kwandong University, International St. Mary's Hospital, Incheon 22711, Republic of Korea.
Int J Ophthalmol. 2020 Feb 18;13(2):292-300. doi: 10.18240/ijo.2020.02.14. eCollection 2020.
To investigate clinical characteristics of asymptomatic Terson syndrome and its clinical impact in patients with aneurysmal subarachnoid hemorrhage (SAH).
This retrospective, interventional study included 31 patients with aneurysmal SAH, and the medical records were reviewed. In addition to baseline characteristics of the study population such as age, sex, and underlying medical history, multi-modal imaging analysis, including fluorescein angiography (FA), spectral domain optical coherence tomography (SD-OCT), were also reviewed. Glasgow Coma Scale (GCS), Hunt-Hess (HH) grade, and Fisher scale at the time of admission, and functional outcome by using modified Rankin Scale (mRS) at 6mo were compared.
Of the 31 patients, 10 patients (32.3%) were diagnosed with Terson syndrome. All the patients with Terson syndrome did not report visual symptoms at the time of ophthalmologic screening. FA showed microvascular changes of retinal capillaries and varying degrees of disc leakage. SD-OCT allowed intuitive anatomical localization of multi-layered retinal hemorrhages and assessment of ellipsoid zone integrity. The patients with Terson syndrome showed significantly worse GCS (=0.047) and HH grade (=0.025) than those without, except Ficher scale (=0.385). There was no significant difference in the mRS (=0.250) at 6mo. Among baseline factors, the HH grade was the only significant factor associated with Terson syndrome (=1.079, =0.016).
In our study, 32.3% of the patients have Terson syndrome without visual symptoms. The baseline HH grade is significantly correlated with Terson syndrome, and there is no significant difference in the functional outcome between the patients with and without Terson syndrome. Terson syndrome may develop without any visual symptoms as shown in our study, and ophthalmologic screening may be recommended to prevent further visual deterioration especially in the patients with poor HH grade at the time of aneurysmal SAH.
探讨无症状性Terson综合征的临床特征及其对动脉瘤性蛛网膜下腔出血（SAH）患者的临床影响。
这项回顾性干预研究纳入了31例动脉瘤性SAH患者，并对其病历进行了回顾。除了研究人群的基线特征，如年龄、性别和基础病史外，还回顾了多模态影像学分析，包括荧光素血管造影（FA）、光谱域光学相干断层扫描（SD-OCT）。比较入院时的格拉斯哥昏迷量表（GCS）、Hunt-Hess（HH）分级和Fisher分级，以及6个月时使用改良Rankin量表（mRS）评估的功能结局。
31例患者中，10例（32.3%）被诊断为Terson综合征。所有Terson综合征患者在眼科筛查时均未报告视觉症状。FA显示视网膜毛细血管的微血管变化和不同程度的视盘渗漏。SD-OCT可以直观地对多层视网膜出血进行解剖定位，并评估椭圆体带的完整性。Terson综合征患者的GCS（=0.0；47）和HH分级（=0.025）明显比无Terson综合征的患者差，Fisher分级除外（=0.385）。6个月时mRS（=0.250）无显著差异。在基线因素中，HH分级是与Terson综合征相关的唯一显著因素（=1.079，=0.016）。
在我们的研究中，32.3%的患者患有无视觉症状的Terson综合征。基线HH分级与Terson综合征显著相关，有和无Terson综合征的患者功能结局无显著差异。如我们的研究所示，Terson综合征可能在没有任何视觉症状的情况下发生，建议进行眼科筛查以预防进一步的视力恶化，尤其是在动脉瘤性SAH时HH分级较差的患者中。
