Ha Young Byun; Hoyeon Jung; Hye Jung Choi; Joong Hoon Lee; Min-Kyun Oh; Chul Ho Yoon; Heesuk Shin; Eun Shin Lee

doi:10.12786/bn.2014.7.2.136

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Byun, Jung, Choi, Lee, Oh, Yoon, Shin, and Lee: Terson Syndrome after Subarachnoid Hemorrhage Occurred by Thrombolysis and Mechanical Thrombectomy to Treat Acute Ischemic Stroke −A Case Report−

Case Report

Brain Neurorehabil 2014;7(2):136-142.

Published online: 29 September 2014

DOI: https://doi.org/10.12786/bn.2014.7.2.136

Terson Syndrome after Subarachnoid Hemorrhage Occurred by Thrombolysis and Mechanical Thrombectomy to Treat Acute Ischemic Stroke −A Case Report−

Ha Young Byun, M.D., Hoyeon Jung, M.D., Hye Jung Choi, M.D., Joong Hoon Lee, M.D., Min-Kyun Oh, M.D., Chul Ho Yoon, M.D., Heesuk Shin, M.D., Eun Shin Lee, M.D.

Department of Rehabilitation Medicine, Gyeongsang National University Graduate School of Medicine, Korea

Correspondence to: Eun Shin Lee, Department of Rehabilitation Medicine, Gyeongsang National University Hospital, 79, Gangnamro, Jinju 660-702, Korea Tel: 055-750-8734, Fax: 055-750-8255 E-mail: rmeslee@gnu.ac.kr

Received 15 April 2014 Revised 5 June 2014 Accepted 25 July 2014

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Terson syndrome is a vitreous hemorrhage associated with subarachnoid hemorrhage. This can be caused by spontaneous, aneurysmal rupture or traumatic subarachnoid hemorrhage, but never has been reported as a consequence of hemorrhage due to thrombolysis and thrombectomy treatments of acute ischemic stroke patient. A 48-year-old man presented with left sided weakness was diagnosed as cerebral infarction on right middle cerebral artery territory due to complete occlusion of right distal internal carotid, middle cerebral, and anterior cerebral artery. He underwent thrombolysis and mechanical thrombectomy, and subarachnoid hemorrhage developed. Later, visual disturbance on right eye occurred so he was consulted to ophthalmology. Vitreous hemorrhage was found and surgery was recommended after two weeks of observation. After pars planar vitrectomy, visual acuity improved, along with functional ability. Therefore, possibilities of Terson syndrome in patients with subarachnoid hemorrhage have to be kept in mind to improve not only visual acuity but also rehabilitation outcome.

Keywords: vitreous hemorrhage, stroke, subarachnoid hemorrhage

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Fig. 1.

Axial images of brain magnetic resonance imaging obtained at the emergency department visit. Note the acute infarction in right basal ganglia and periventricular white matter.

Fig. 2.

MR angiography with Gadolinium demonstrates complete occlusion of right distal ICA, right MCA and right ACA.

Fig. 3.

Axial images of brain computed tomography image taken immediately after the mechanical thrombolysis shows SAH with extravasated contrast media in right basal ganglia and periventricular white matter.

Fig. 4.

Ten hours later, hemorrhage resolved and extravasated contrast media disappeared.

Fig. 5.

(A) Funduscopic photograph shows vitreous hemorrhage (grade 4; dense vitreous hemorrhage with no red reflex) on right eye. (B) Funduscopic photograph shows resolved vitresous hemorrhage (grade 0; no blood present in vitreous and entire retina is visible) on right eye.

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