title: Terson's syndrome as a prognostic factor for mortality of spontaneous subarachnoid haemorrhage.
abstract: OBJECTIVE
  To evaluate the prognosis of mortality in patients with spontaneous subarachnoid haemorrhage associated with Terson's syndrome.
  
  
  METHODS
  A prospective, consecutive case series study was conducted in patients admitted to the emergency room with a diagnosis of acute subarachnoid haemorrhage. After a complete neurological examination, funduscopic examination using binocular indirect ophthalmoscopy under mydriasis was performed upon admission and at days 3, 7, 30 and 60 after the onset. In all cases, the diagnosis of intracranial bleeding was made by computerized tomography, and the clinical condition was graded according to the Hunt & Hess and Glasgow coma scales.
  
  
  RESULTS
  Forty-seven patients with the diagnosis of subarachnoid haemorrhage were enrolled. Forty-four cases were associated with a ruptured aneurysm and three cases with arterio-venous malformation. Fourteen patients (29%) were diagnosed with Terson's syndrome. Seven patients (50%) with Terson's syndrome died, whereas death occurred in three patients (9%) without Terson's syndrome (p = 0.002). Ocular findings in Terson's syndrome were preretinal, intraretinal, sub-retinal and vitreous haemorrhage. Associated ocular findings included third-nerve palsy, papilloedema and subconjunctival haemorrhage.
  
  
  CONCLUSIONS
  The presence of Terson's syndrome was associated with an increased mortality rate (50% versus 9%; p < 0.01). Therefore, patients with the diagnosis of intracranial haemorrhage should be submitted to a funduscopic examination, because the presence of intraocular haemorrhage is an important life-threatening prognostic factor.
authors.affiliation: Department of Ophthalmology, Federal University of São Paulo, Brazil. sesong@oftalmo.epm.br
authors.forename: Watanabe
authors.initials: W
authors.lastname: Sung
authors.forename: Bordon
authors.initials: B
authors.lastname: Arnaldo
authors.forename: Cavalheiro
authors.initials: C
authors.lastname: Sergio
authors.forename: Sallum
authors.initials: S
authors.lastname: Juliana
authors.forename: Farah
authors.initials: F
authors.lastname: Michel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017542:Aneurysm, Ruptured / Q000175:diagnosis / Q000401:mortality*; D001165:Arteriovenous Malformations / Q000175:diagnosis / Q000401:mortality*; D001938:Brazil / Q000453:epidemiology; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000175:diagnosis / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009887:Ophthalmoscopy; D011379:Prognosis; D011446:Prospective Studies; D012166:Retinal Hemorrhage / Q000175:diagnosis / Q000401:mortality*; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis / Q000401:mortality*; D014057:Tomography, X-Ray Computed; D014823:Vitreous Hemorrhage / Q000175:diagnosis / Q000401:mortality*