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TERSON’S SYNDROME Z. Jamaleddine, S. El Haddad, A. El Quessar Service de Radiologie, Hopital Cheikh Zaid Rabat - Morocco
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Introduction Terson’s syndrome is the association of vitreous or retinal haemorrhage with subarachnoid haemorrhage (SAH). The diagnosis is typically made fundoscopically.
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Objectives To describe, the clinical, radiological characteristics of this syndrome. To describe the therapeutic indications.
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Materials and methods Three cases hospitalised for subarachnoid haemorrhage (SAH) and secondary complicated by intravitreous haemorrhage. Imaging exploration based on: Computer tomography 16 bars, MRI 1.5 Tesla, Cerebral angiography. Ocular ultrasonography intravitreous haemorrhage. All patients were treated by embolisation for the etiology of SAH : two aneurysms and one AVM. SAH
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37 years old woman, Left hemiplegia. CASE 1
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After several sessions of embolization
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Three months later: loss of vision in a right eye
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Diagnosis of Terson syndrome Treatment: Vitrectomy after 5 months Visual acuity improved immediately
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A 28 years old male Headache, vomiting and VI paralysis t Case 2
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Ten days later : Blindness of left eye
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Diagnosis of Terson syndrome Treatment: Vitrectomy after 2 months Recovery of visual acuity
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Woman of 51 years Case 3
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One week after: impairment of right visual acuity.
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Diagnosis of Terson syndrome Vitrectomy is programmed, despite a partial improvement of vision
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Discussion Terson syndrome mentioned for the first time in 1900. Vitreous haemorrhage: <10% of ruptured intracranial aneurysm. Bilateral: 14% - 60% of cases. Intraocular haemorrhage AdultChildren The rate in %18 - 41 70
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Discussion Etiology: Ruptured aneurysm AVM Traumatic cause = very rare. Clinical manifestation: the significant decrease in visual acuity is the most common symptom. The most common cause
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Ultrasound search: Characteristic of intravitreous haemorrhage Dense, Mobile: feature of Terson syndrome Abundant, Posterior vitreous detachment usually total. Retinal detachment
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Vitrectomy has been shown to be extremely effective in clearing the vitreous haemorrhage Indications: Patients with intraocular bilateral haemorrhage There is not signs of spontaneous resorption after 1 to 3 month.
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Conclusion It appears necessary to examine visual acuity in case of subarachnoid haemorrhage for an early diagnosis and the better treatment of this rare syndrome.
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