A systematic review of Terson’s syndrome: frequency and prognosis after subarachnoid haemorrhage
- 1Department of Neurology, Royal Victoria Hospital, Belfast, UK
- 2Department of Neurology, Northwestern University Medical School, Chicago, Illinois, USA
- 3Department of Epidemiology and Public Health Medicine, Queen’s University of Belfast
- Correspondence to: Dr Mark McCarron Department of Neurology, Altnagelvin Hospital, Londonderry BT47 6SB, UK;
- Received 4 May 2003
- Accepted 5 August 2003
- Revised 28 July 2003
Objective: To review systematically the frequency and prognostic significance of vitreous haemorrhage in patients with subarachnoid haemorrhage (Terson’s syndrome).
Methods: Papers relating to vitreous haemorrhage in patients with subarachnoid haemorrhage were retrieved. The only studies considered were those with at least 10 consecutive cases of subarachnoid haemorrhage with or without vitreous haemorrhage. The frequency of vitreous haemorrhage in such cases was calculated in prospective and retrospective studies. Mortality was compared in patients with and without Terson’s syndrome.
Results: 154 papers were reviewed. Three prospective studies and six retrospective studies satisfied the inclusion criteria. Of 181 patients with subarachnoid haemorrhage assessed prospectively (mean age, 51.7 years), 24 (13%) had vitreous haemorrhage; among 1086 retrospective records, 37 (3%) had documented vitreous haemorrhage (p<0.001). Patients with Terson’s syndrome had higher Hunt and Hess grades than those without (mean grade, 3.6 v 2.6). Patients with Terson’s syndrome were also more likely to die (13 of 30 (43%) v 31 of 342 (9%); odds ratio 4.8; p<0.001).
Conclusions: Prospective studies show a higher frequency of Terson’s syndrome than retrospective studies, suggesting that vitreous haemorrhage is not well documented. Vitreous haemorrhage is an adverse prognostic finding in patients with subarachnoid haemorrhage.
Competing interests: none declared