SCREENING FOR OCULAR HEMORRHAGES IN PATIENTS WITH RUPTURED CEREBRAL ANEURYSMS - A PROSPECTIVE-STUDY OF 99 PATIENTS

BACKGROUND: Terson's syndrome (vitreous hemorrhage) and other ocular h emorrhages (retinal hemorrhages) have been reported to occur in up to 40% of patients with ruptured cerebral aneurysms. Because microsurgica l vitrectomy can safely restore vision in patients with visual loss se condary to Terson's syndrome, we hypothesized that prospectively scree ning a selected group of patients with aneurysms would result in a hig her rate of vitrectomy in patients with more extensive subarachnoid he morrhage. METHODS: Ninety-nine patients with ruptured cerebral aneurys ms were prospectively screened for Terson's syndrome and other forms o f ocular hemorrhage by an ophthalmologist. Follow-up data were obtaine d for seven of eight cases of Terson's syndrome, and vitrectomy was pe rformed for visual restoration when indicated. RESULTS: Ocular hemorrh ages were present in 17% of patients with ruptured cerebral aneurysms, and Terson's syndrome was present in 8% of patients. Screening of pat ients with histories of transient or prolonged comas sensitively ident ified patients with ocular hemorrhages in 100% of the patients with Te rson's syndrome and 89% of the patients with other ocular hemorrhages. Fifty-five percent of the patients in the overall series had historie s of transient or prolonged comas, and 53% (specificity) of those pati ents had ocular hemorrhages. Two of the eight patients with Terson's s yndrome underwent vitrectomy, with dramatic improvement in vision. No other ocular hemorrhages required surgery. CONCLUSIONS: Ophthalmologic al screening of patients with histories of transient or prolonged coma s after ruptured cerebral aneurysms very sensitively identifies patien ts with ocular hemorrhages, which are relatively common in patients wi th subarachnoid hemorrhage treated in an academic neurosurgical practi ce. The present study underestimates the true incidence of Terson's sy ndrome in that patients who died shortly after their subarachnoid hemo rrhage were not included. Vitrectomy for patients who do not exhibit s pontaneous improvement in vision results in a dramatic reversal of bli ndness.