Subarachnoid hemorrhage-negative Terson syndrome after balloon-assisted coil embolization in a patient with underlying antiphospholipid antibody syndrome.
OBJECTIVE
To report subarachnoid hemorrhage-negative Terson syndrome after coil embolization of an unruptured intracranial aneurysm in a patient with underlying antiphospholipid syndrome.


METHODS
Retrospective case report. A 48-year-old woman with underlying antiphospholipid syndrome.


RESULTS
Our patient underwent balloon-assisted coil embolization of an unruptured right internal carotid artery aneurysm. There was herniation of the second coil requiring coil retrieval with subsequent nonflow limiting herniation of the first coil left in situ on anticoagulation. In the immediate postprocedure period, she developed preretinal, intraretinal, and vitreous hemorrhages requiring temporary withholding of anticoagulation therapy with careful resumption. Visual acuity was counting fingers and there was an afferent pupillary defect. Two week after discharge, the patient underwent a pars plana vitrectomy for dense breakthrough vitreous hemorrhage. Four weeks after pars plana vitrectomy, her visual acuity was 20/400.


CONCLUSIONS
Terson syndrome should be considered in a patient with visual symptoms after not only aneurysmal subarachnoid hemorrhage but also non-subarachnoid hemorrhage elective aneurysm coiling as demonstrated by our case.
*Department of Neurological Surgery, Neurological Institute of New Jersey, New Jersey Medical School, Rutgers University, Newark, New Jersey; and †Institute of Ophthalmology and Visual Science, New Jersey Medical School, Rutgers University, Newark, New Jersey.
Vikas
V
Gupta
Anton M
AM
Kolomeyer
Neelakshi
N
Bhagat
Roger E
RE
Turbin
Charles J
CJ
Prestigiacomo
Chirag D
CD
Gandhi
D016736:Antiphospholipid Syndrome / Q000150:complications*; D001014:Aortic Aneurysm / Q000601:surgery*; D021721:Balloon Occlusion / Q000009:adverse effects*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008875:Middle Aged; D011183:Postoperative Complications; D012166:Retinal Hemorrhage / Q000209:etiology; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000209:etiology*; D014823:Vitreous Hemorrhage / Q000209:etiology