TERSON-SYNDROME - CT EVALUATION IN 12 PATIENTS

PURPOSE: Terson syndrome may be overlooked in the acute setting and of ten requires ophthalmologic intervention to prevent long-term visual l oss. In this syndrome, vitreous or retinal hemorrhage results from an abrupt rise in intracranial pressure, leading to retinal venous hypert ension and intraocular hemorrhage. Our objective was to determine whet her imaging findings could be discovered that might facilitate an earl ier diagnosis. METHODS: Our inpatient medical record data base for 199 1-1996 listed 11 patients with Terson syndrome. The medical records of these 11 patients were reviewed retrospectively and compared with the ir noncontrast head CT scans and with scans of 10 control subjects. On e additional case was discovered prospectively, for a total of 12 pati ents. Three radiologists unaware of the patients' history evaluated CT scans of the orbits for evidence of intraocular hemorrhage. RESULTS: CT findings in eight patients were suggestive of retinal hemorrhage ma nifested by a retinal crescent or nodule that was slightly hyperdense relative to the vitreous humor. There was a high degree of concordance between the retrospective and independent reviews. CONCLUSION: Retina l nodularity and crescentic hyperdensities are evident on CT scans in the majority of patients with Terson syndrome. Although findings are s ubtle and not present in all cases, in the setting of subarachnoid hem orrhage they suggest retinal hemorrhage and warrant detailed fundoscop ic evaluation.