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INTRODUCTION: The concomitance of vitreous and/or subhyaloid
hemorrhage (Terson syndrome; TS) and aneurysmal
subarachnoid hemorrhage (SAH) has frequently been shown.
However, there is a broad variation of reported prevalence of
TS and only few cases are diagnosed in the neurosurgical unit.
In this prospective study the authors determined the incidence
of Terson syndrome (TS) in patients suffering from SAH and attempted to identify the prognostic relevance in terms of patient outcome.

METHODS: Over a period of 12 months a total of 69 patients
suffering from SAH were included in this analysis. The
admitting Glasgow Coma Scale scores (GCS), Hunt&Hess
grades, and Fisher grades were documented. All participants
were ophthalmologically examined. The exact anatomical localisation of the aneurysm was recorded. Surgical clipping and
endovascular coiling was performed in 48 patients. At discharge
from the hospital the outcome was assessed using the Glasgow Outcome Scale (GOS).

RESULTS: In a 1-year period, a total of 69 SAH patients (17
men and 52 women) with a mean age of 54.2 years (range
27–86 years) were admitted to our clinic. 11 patients (15.9%)
revealed a TS within 24 hours after the aneurysm rupture (3
men and 11 women). In 6 patients the TS occurred bilaterally,
in the remaining 5 patients only the right eye was affected. The
hemorrhage was in a statistically significant correlation with
either high Fisher- (3.0 vs. 2.36) or Hunt & Hess (4.0 vs. 2.82) scores or low GCS (5.0 vs. 11.96) scores. Especially aneurysms of the internal carotid artery (ICA; 4 patients) predisposed
in a significant way for the development of TS in our cohort.
Compared with the non-TS group, patients with TS displayed
significantly higher mortality (36.4% vs. 11.6%) and worse
functional outcome as being reflected by GOS 2 (27.3% vs.
5.8%), even though this observation was not significant.

CONCLUSIONS: Terson hemorrhage is a frequent clinical finding in SAH patients. It is likely to occur in severe SAH with high Hunt
& Hess- and Fisher- scores and low GCS scores. Presence of TS may indicate a severe hospital course and a worse functional outcome of the patient. Especially in SAH patients bearing
ruptured ICA aneurysms, an ophthalmological examination
should be performed. Early recognition of TS is important since
diminution of visual acuity even to functional blindness in the bilateral cases may be highly hindering to the patient and hamper the rehabilitation process considerably.