Terson syndrome
Introduction
Introduction to Terson Syndrome In 1900, Terson first reported that intracranial hemorrhage can be the cause of vitreous hemorrhage, and that this ocular-brain syndrome is a sign of subarachnoid hemorrhage, called Terson syndrome. basic knowledge The proportion of illness: 0.006% Susceptible people: no specific population Mode of infection: non-infectious Complications: retinal detachment glaucoma
Cause
Causes of Terson syndrome
(1) Causes of the disease
It is generally believed to be associated with increased intracranial pressure caused by various causes.
(two) pathogenesis
The mechanism of occurrence has always been controversial. It is thought that the increase of intracranial pressure causes the subarachnoid hemorrhage to enter the eye through the sieve plate, but it is generally believed that it may be a sudden increase of intracranial pressure, and the pressure is transmitted to the retinal blood vessels, making the retinal vein The rupture and bleeding, Keithahn pathological examination of the pre-retinal "swatch-like" tissue of patients with Terson syndrome complicated with vitreous hemorrhage, found to be the inner limiting layer of the retina, thus speculating that Terson syndrome is due to sudden cranial The internal pressure is increased, and the retinal small blood vessels rupture and hemorrhage, resulting in the separation of the inner limiting membrane and the retina. If the amount of bleeding is small, the blood accumulates between the layers of the retina, but when the amount of bleeding is large, the inner limiting membrane can be torn. A large amount of blood is poured into the vitreous. In patients with vitreous blood of chronic Terson syndrome, due to vitreous hemorrhage, it provides an opportunity for the proliferation of retinal glial cells to promote the formation of a mechanical membrane. The bleeding also contains cell growth factors. Promote cell migration and proliferation, and finally form a mechanical traction and cause retinal detachment.
Prevention
Terson syndrome prevention
Limit animal fats such as lard, butter, butter, etc., as well as foods high in cholesterol, such as egg yolks, caviar, animal offal, and fat.
Complication
Terson syndrome complications Complications, retinal detachment, glaucoma
Rhegmatogenous retinal detachment and secondary glaucoma are common.
Symptom
Symptoms of Terson syndrome Common symptoms Retinal hemorrhage Visual impairment Vitreous blood retinal detachment from fundus hemorrhage and exudation
According to the amount of intraocular blood loss, there may be different degrees of visual impairment. If there is only a small amount of bleeding between the retinal layers, the visual acuity is not obvious. If the bleeding is located in the macular area or a large amount of bleeding enters the vitreous cavity, the visual acuity drops sharply. The degree of internal bleeding is related to the speed of intracranial hemorrhage and whether there is cerebral edema. The vitreous hemorrhage can occur simultaneously in the subarachnoid hemorrhage, or it can occur later. Some patients develop glass two weeks after the occurrence of subarachnoid hemorrhage. Volumetric blood, some bleeding can accumulate under the inner limiting membrane and not into the vitreous, and some vitreous hemorrhage occurs in the intracranial rebleeding. The vitreous hemorrhage is firstly diffuse red turbidity of different degrees in the posterior pole. The peripheral retina of the patient can still be seen clearly.
Some patients have a retinal anterior membrane after retinal hemorrhage. In 11 patients (16 eyes) with Terson syndrome, 10 eyes have a retinal anterior membrane, mostly a monolayer membrane, and within the inner limiting membrane of the retina. However, some membranes are formed again in front of the retina. These membranes are not vascular-derived. Some patients may have detachment of the inner retinal membrane. Occasionally, rhegmatogenous retinal detachment occurs. McRae reports a case of binocular synthesis. Retinal detachment occurred in the sign. The reason may be due to the loss of retinal detachment due to vitreous hemorrhage and posterior vitreous detachment. A case report of vitreous hemorrhage occurred in a patient after subarachnoid hemorrhage, followed by For glaucoma, the intraocular pressure is as high as 5.33 kPa (40 mmHg) or more.
Examine
Examination of Terson syndrome
The necessary laboratory tests were carried out for different causes of intracranial hemorrhage to determine the initiating factors of blood accumulation in the vitreous.
1. Head CT and MRI examination
It is possible to determine the location, extent, and estimated amount of intracranial hemorrhage, and to determine the condition.
2. Ophthalmology B-ultrasound
1 A small amount of diffuse bleeding may result in a negative result with B-mode ultrasound because there is insufficient echogenic interface in the vitreous, while A-mode ultrasound scan may show a low baseline echo, 2 when the vitreous hemorrhage is dense The low-to-moderate amplitude of the scattered echo can be seen in both type A or B-mode ultrasound examinations. When scanning with high sensitivity, the density and distribution of bleeding are more clearly displayed; the scanning of reduced sensitivity can be echoed. As the amplitude decreases, most of the echo points are removed, so it can be determined whether retinal detachment is present at the same time.
Diagnosis
Diagnosis and identification of Terson syndrome
According to the patient's history of intracranial hemorrhage, it is not difficult to make a diagnosis after excluding the bleeding disorder that causes the eye itself, such as sudden visual loss of the patient, and bleeding of the vitreous or retina during the examination.
B-ultrasound can be distinguished from retinal detachment, and the patient has a history of intracranial hemorrhage.
