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Terson syndrome in aneurysmal subarachnoid hemorrhage—its relation to intracranial pressure, admission factors, and clinical outcome

  • Clinical Article - Vascular
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Abstract

Background

A large number of reports have not been able to clarify the pathophysiology of Terson syndrome (TS) in aneurysmal subarachnoid hemorrhage (aSAH).

Methods

Prospective single-center study on aSAH patients. Fundoscopic and radiological signs of TS were assessed. The opening intracranial pressure (ICP) in patients who required a ventriculostomy was recorded with a manometer.

Results

Six out of 36 included patients had TS (16.7 %), which was associated with unfavorable admission scores. Twenty-nine patients (80.5 %) required ventriculostomy; TS was associated with higher ICP (median, 40 vs. 15 cm cmH2O, p = .003); all patients with TS had pathological ICP values of >20 cmH2O. Patients with a ruptured aneurysm of the anterior cerebral artery complex were ten times as likely to suffer from TS (OR 10.0, 95 % CI 1.03–97.50). Detection of TS on CT had a sensitivity of 50 %, a specificity of 98.4 %, a positive predictive value of 83.3 %, and a negative predictive value of 92.4 %. Mortality was 45 times as high in patients with TS (OR 45.0, 95 % CI 3.86–524.7) and neurologic morbidity up until 3 months post-aSAH was significantly higher in patients with TS (mRS 4–6; 100 vs. 17 %; p = .001).

Conclusions

Our findings demonstrate an association between raised ICP and the incidence of TS. TS should be ruled out in aSAH patients presenting comatose or with raised ICP to ensure upfront ophthalmological follow-up. In alert patients without visual complaints and a TS-negative CT scan, the likelihood for the presence of TS is very low.

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Acknowledgments

The authors thank their study nurse, Cornelia Lüthi, for her excellent follow-up questionnaires management and Carolin Hock for proofreading the manuscript.

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Authors and Affiliations

  1. Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland

    Holger Joswig, Lorenz Epprecht, Gerhard Hildebrandt, Jean-Yves Fournier & Martin Nikolaus Stienen

  2. Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Christophe Valmaggia

  3. Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland

    Sebastian Leschka

  4. Department of Neurosurgery and Faculté de Médicine, University Hospital of Geneva, Geneva, Switzerland

    Martin Nikolaus Stienen

Authors
  1. Holger Joswig
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  2. Lorenz Epprecht
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  3. Christophe Valmaggia
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  4. Sebastian Leschka
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  5. Gerhard Hildebrandt
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  7. Martin Nikolaus Stienen
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Corresponding author

Correspondence to Holger Joswig.

Ethics declarations

All persons provided informed consent prior to their inclusion in the study.

Conflicts of interest

The authors declare that they have no conflict of interest. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements), or non-financial interest (such as personal or professional relationships, affiliations, knowledge or beliefs) in the subject matter or materials discussed in this manuscript.

Funding

For a parallel study on CSF-biomarkers (registered under the same Identifier NCT0212901), CSF-protein INNOTEST® ELISA test kits were provided by Innogenetics N.V. (Ghent, Belgium); this funding source had no role in the design or conduct of this research.

Ethical approval

All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. The study was approved by the Ethics Committee St. Gallen, Switzerland (EKSG 13/011/1B).

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Joswig, H., Epprecht, L., Valmaggia, C. et al. Terson syndrome in aneurysmal subarachnoid hemorrhage—its relation to intracranial pressure, admission factors, and clinical outcome. Acta Neurochir 158, 1027–1036 (2016). https://doi.org/10.1007/s00701-016-2766-8

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  • DOI: https://doi.org/10.1007/s00701-016-2766-8

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