Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage

Predisposing factors and prognostic significance

Kostas N. Fountas, Eftychia Z. Kapsalaki, Gregory P Lee, Theofilos G. Machinis, Arthur A. Grigorian, Joe S. Robinson, Ioannis Vergados, Panagiotis G. Theodosiadis

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Object. The association of vitreous and/or subhyaloid hemorrhage with aneurysmal subarachnoid hemorrhage (SAH) has been frequently identified since the original description by Terson in 1900. In this prospective clinical study the authors examined the actual incidence of Terson hemorrhage in patients suffering aneurysmal SAH, they attempted to identify those parameters that could predispose its development, and they evaluated its prognostic significance in the overall patients' outcome. Methods. A total of 174 patients suffering aneurysmal SAH were included in this study. The admitting Glasgow Coma Scale scores (GCS), World Federation of Neurological Societies (WFNS) scale scores, Hunt and Hess grades, and Fisher grades were recorded. A careful ophthalmological evaluation was performed in all participants. The exact anatomical locations and the largest diameter of the dome of the ruptured aneurysms were also recorded. Surgical clipping or endovascular coiling was used in 165 patients. Clinical outcome was evaluated at discharge from the hospital by using the Glasgow Outcome Scale and the modified Rankin Scale. Periodic ophthalmological evaluations were performed for 2 years. Results. In this series, the observed incidence of Terson hemorrhage was 12.1%. Statistical analysis of our data demonstrated that patients with low GCS scores and high WFNS scores, Hunt and Hess grades, and Fisher grades had an increased incidence of Terson hemorrhage. The mortality rate for patients with Terson hemorrhage was 28.6%, whereas that for patients without Terson hemorrhage was 2.0%. Moreover, patients with Terson hemorrhage who survived had significantly worse outcomes than those in patients without Terson hemorrhage. Conclusions. Terson hemorrhage constitutes a common SAH-associated complication. Its incidence is increased in patients with low GCS and high WFNS scores, and high Hunt and Hess and Fisher grades. Its presence is associated with increased mortality and morbidity rates.

Original languageEnglish (US)
Pages (from-to)439-444
Number of pages6
JournalJournal of neurosurgery
Volume109
Issue number3
DOIs
StatePublished - Sep 1 2008

Fingerprint

Subarachnoid Hemorrhage
Causality
Hemorrhage
Glasgow Coma Scale
Incidence
Glasgow Outcome Scale
Statistical Data Interpretation
Ruptured Aneurysm
Mortality
Prospective Studies
Morbidity

Keywords

  • Aneurysm location
  • Aneurysm size
  • Clinical outcome
  • Mortality rate
  • Subarachnoid hemorrhage
  • Terson hemorrhage

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Fountas, K. N., Kapsalaki, E. Z., Lee, G. P., Machinis, T. G., Grigorian, A. A., Robinson, J. S., ... Theodosiadis, P. G. (2008). Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: Predisposing factors and prognostic significance. Journal of neurosurgery, 109(3), 439-444. https://doi.org/10.3171/JNS/2008/109/9/0439

Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage : Predisposing factors and prognostic significance. / Fountas, Kostas N.; Kapsalaki, Eftychia Z.; Lee, Gregory P; Machinis, Theofilos G.; Grigorian, Arthur A.; Robinson, Joe S.; Vergados, Ioannis; Theodosiadis, Panagiotis G.

In: Journal of neurosurgery, Vol. 109, No. 3, 01.09.2008, p. 439-444.

Research output: Contribution to journalArticle

Fountas, KN, Kapsalaki, EZ, Lee, GP, Machinis, TG, Grigorian, AA, Robinson, JS, Vergados, I & Theodosiadis, PG 2008, 'Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: Predisposing factors and prognostic significance', Journal of neurosurgery, vol. 109, no. 3, pp. 439-444. https://doi.org/10.3171/JNS/2008/109/9/0439
Fountas, Kostas N. ; Kapsalaki, Eftychia Z. ; Lee, Gregory P ; Machinis, Theofilos G. ; Grigorian, Arthur A. ; Robinson, Joe S. ; Vergados, Ioannis ; Theodosiadis, Panagiotis G. / Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage : Predisposing factors and prognostic significance. In: Journal of neurosurgery. 2008 ; Vol. 109, No. 3. pp. 439-444.
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abstract = "Object. The association of vitreous and/or subhyaloid hemorrhage with aneurysmal subarachnoid hemorrhage (SAH) has been frequently identified since the original description by Terson in 1900. In this prospective clinical study the authors examined the actual incidence of Terson hemorrhage in patients suffering aneurysmal SAH, they attempted to identify those parameters that could predispose its development, and they evaluated its prognostic significance in the overall patients' outcome. Methods. A total of 174 patients suffering aneurysmal SAH were included in this study. The admitting Glasgow Coma Scale scores (GCS), World Federation of Neurological Societies (WFNS) scale scores, Hunt and Hess grades, and Fisher grades were recorded. A careful ophthalmological evaluation was performed in all participants. The exact anatomical locations and the largest diameter of the dome of the ruptured aneurysms were also recorded. Surgical clipping or endovascular coiling was used in 165 patients. Clinical outcome was evaluated at discharge from the hospital by using the Glasgow Outcome Scale and the modified Rankin Scale. Periodic ophthalmological evaluations were performed for 2 years. Results. In this series, the observed incidence of Terson hemorrhage was 12.1{\%}. Statistical analysis of our data demonstrated that patients with low GCS scores and high WFNS scores, Hunt and Hess grades, and Fisher grades had an increased incidence of Terson hemorrhage. The mortality rate for patients with Terson hemorrhage was 28.6{\%}, whereas that for patients without Terson hemorrhage was 2.0{\%}. Moreover, patients with Terson hemorrhage who survived had significantly worse outcomes than those in patients without Terson hemorrhage. Conclusions. Terson hemorrhage constitutes a common SAH-associated complication. Its incidence is increased in patients with low GCS and high WFNS scores, and high Hunt and Hess and Fisher grades. Its presence is associated with increased mortality and morbidity rates.",
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T2 - Predisposing factors and prognostic significance

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AU - Kapsalaki, Eftychia Z.

AU - Lee, Gregory P

AU - Machinis, Theofilos G.

AU - Grigorian, Arthur A.

AU - Robinson, Joe S.

AU - Vergados, Ioannis

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KW - Aneurysm location

KW - Aneurysm size

KW - Clinical outcome

KW - Mortality rate

KW - Subarachnoid hemorrhage

KW - Terson hemorrhage

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