title: Terson syndrome in aneurysmal subarachnoid hemorrhage-its relation to intracranial pressure, admission factors, and clinical outcome.
abstract: A large number of reports have not been able to clarify the pathophysiology of Terson syndrome (TS) in aneurysmal subarachnoid hemorrhage (aSAH).
  
  
  
  Prospective single-center study on aSAH patients. Fundoscopic and radiological signs of TS were assessed. The opening intracranial pressure (ICP) in patients who required a ventriculostomy was recorded with a manometer.
  
  
  
  Six out of 36 included patients had TS (16.7 %), which was associated with unfavorable admission scores. Twenty-nine patients (80.5 %) required ventriculostomy; TS was associated with higher ICP (median, 40 vs. 15 cm cmH2O, p = .003); all patients with TS had pathological ICP values of >20 cmH2O. Patients with a ruptured aneurysm of the anterior cerebral artery complex were ten times as likely to suffer from TS (OR 10.0, 95 % CI 1.03-97.50). Detection of TS on CT had a sensitivity of 50 %, a specificity of 98.4 %, a positive predictive value of 83.3 %, and a negative predictive value of 92.4 %. Mortality was 45 times as high in patients with TS (OR 45.0, 95 % CI 3.86-524.7) and neurologic morbidity up until 3 months post-aSAH was significantly higher in patients with TS (mRS 4-6; 100 vs. 17 %; p = .001).
  
  
  
  Our findings demonstrate an association between raised ICP and the incidence of TS. TS should be ruled out in aSAH patients presenting comatose or with raised ICP to ensure upfront ophthalmological follow-up. In alert patients without visual complaints and a TS-negative CT scan, the likelihood for the presence of TS is very low.
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland. holger.joswig@gmail.com.
authors.forename: Holger
authors.identifier: 0000-0003-3540-3910
authors.initials: H
authors.lastname: Joswig
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Lorenz
authors.initials: L
authors.lastname: Epprecht
authors.affiliation: Department of Ophthalmology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Christophe
authors.initials: C
authors.lastname: Valmaggia
authors.affiliation: Division of Radiology and Nuclear Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Leschka
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Gerhard
authors.initials: G
authors.lastname: Hildebrandt
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Fournier
authors.affiliation: Department of Neurosurgery, Cantonal Hospital St. Gallen, Rorschacher Strasse 95, 9007, St. Gallen, Switzerland.|Department of Neurosurgery and Faculté de Médicine, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Martin Nikolaus
authors.initials: MN
authors.lastname: Stienen
mesh_terms: D000328:Adult; D000368:Aged; D017542:Aneurysm, Ruptured / Q000150:complications; D005260:Female; D006801:Humans; D007427:Intracranial Pressure; D008297:Male; D008875:Middle Aged; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000175:diagnosis; D014823:Vitreous Hemorrhage / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*
keywords: External ventricular drain; Intracranial pressure; Ocular hemorrhage; Retinal hemorrhage; Subarachnoid hemorrhage; Terson syndrome; Vitreous hemorrhage