Incidence, morbidity, and mortality of Terson syndrome in Hamilton, Ontario.
OBJECTIVE
Evaluate the incidence, neurologic morbidity, and mortality of patients with Terson syndrome.


METHODS
Consecutive patients admitted to the Hamilton General Hospital from May 2012 to May 2013 with a diagnosis of spontaneous subarachnoid hemorrhage (SAH) were recruited. Funduscopic examinations were performed under pharmacological mydriasis. Outcome measures included: (1) the presence or absence of Terson syndrome; (2) The Glasgow Coma Scale (GCS), Hunt and Hess scale (H&H), and SAH Fisher score upon admission to the hospital; (3) the modified Rankin score upon discharge; and (4) and all-cause mortality.


RESULTS
Forty-six patients were included and 10 had Terson syndrome (21%). The median H&H, GCS, and Fisher scores were 4, 6.5, and 4.0 for patients with Terson syndrome vs. 2, 14, and 3 for patients without Terson syndrome (p=0.0032, 0.0052, and 0.031), respectively. The median Rankin score was 6 for patients with Terson syndrome vs. 3.5 for patients without Terson syndrome (p=0.0019). The odds of all-cause mortality with Terson syndrome vs. no Terson syndrome was 12: 1 (95% confidence interval 2.33-61.7), p =0.003. Only four of the 10 patients with Terson syndrome survived.


CONCLUSIONS
Based on this study, approximately one-fifth of patients admitted to the hospital with a spontaneous SAH could have Terson syndrome. Patients with Terson syndrome have significantly worse GCS and H&H scores upon admission to the hospital, lower modified Rankin scores upon discharge, and greater mortality. Thus, Terson syndrome is not rare among patients with SAH and carries a worse prognosis.
1Division of Ophthalmology,McMaster University,Hamilton,Ontario,Canada.
Gamal I
GI
Seif
2Department of Ophthalmology,University of Ottawa,Ottawa,Ontario,Canada.
Joshua C
JC
Teichman
3Division of Neurosurgery,McMaster University,Hamilton,Ontario,Canada.
Kesava
K
Reddy
4Clinical Neurosurgical Unit,Hamilton General Hospital.
Charmaine
C
Martin
5Division of Ophthalmology,McMaster University,Hamilton,Ontario,Canada.
Amadeo R
AR
Rodriguez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009026:Mortality / Q000639:trends; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D013345:Subarachnoid Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality; D013577:Syndrome; D014823:Vitreous Hemorrhage / Q000175:diagnosis* / Q000453:epidemiology* / Q000401:mortality