A systematic review of Terson's syndrome: frequency and prognosis after subarachnoid haemorrhage

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.     

Cryptogenic spontaneous subarachnoid haemorrhage

Patients with spontaneous primary subarachnoid haemorrhage (SAH) in whom initial diagnostic investigation, including cerebral four-vessel angiography, does not reveal a cause, present a difficult problem. In a series of 95 patients a cause became apparent in about 10% of cases during the first three weeks, predominantly missed aneurysms. After three weeks the clinical evolution was benign. Cryptogenic SAH seems to be a disease of its own, but in the individual case the possibility of missed aneurysm or later of no re-bleed aneurysm always remains.     

Epidemiological aspects of spontaneous subarachnoid haemorrhage in Queensland, Australia.

AIMS: To examine the epidemiology of spontaneous subarachnoid haemorrhage (SAH) within the population of Queensland, Australia in 2002. METHODS: A retrospective population and hospital-based survey of all cases of spontaneous SAH occurring within the population of Queensland (3.7 million) during the calendar year 2002 was performed. Cases were identified from hospital separation coding data and the register of births, deaths and marriages. Standard demographic data was recorded for each case identified. RESULTS: The annual incidence of SAH in our population was 9.4 cases per 100,000. There was a steady increase in the incidence of SAH with increasing age, with the incidence rising to 38.8 per 100,000 in those aged greater than 80. The overall mortality rate was 33.1%, with 6% of all cases dying before reaching hospital care. The annual incidence in the indigenous population of Queensland was 8.9 /100,000.     

Chronic spinal arachnoiditis following intracranial subarachnoid haemorrhage

A 54-year-old woman presented with progressive gait imbalance and increased urinary frequency, associated with spinal arachnoiditis. The symptoms started after the occurrence of communicating hydrocephalus as a sequel of subarachnoid haemorrhage (SAH), and were initially attributed to post-SAH vasospasm, decompensating hydrocephalus and/or periventricular leuko-encephalopathy. Further clinical deterioration led to the diagnosis of thoracic spinal arachnoiditis, as a second complication of SAH.     

CSF spectrophotometry in the diagnosis and exclusion of spontaneous subarachnoid haemorrhage.

AIMS: To assess the sensitivity and specificity of CSF spectrophotometry for the detection of xanthochromia in patients with clinical symptoms suggestive of subarachnoid haemorrhage (SAH) but normal cranial computed tomography (CT). METHODS: All consecutive patients undergoing both cranial CT and lumbar puncture for investigation of possible SAH at the Princess Alexandra Hospital, Brisbane, between January 2000 and April 2003 were included in the study. All case histories, radiology and laboratory results were retrospectively assessed. The sensitivity, specificity and positive predictive value of the spectrophotometry test were calculated. RESULTS: 253 patients were included in the study. Spectrophotometry was shown to have a sensitivity of 100% but a specificity of only 75.2%. The positive predictive value of spectrophotometry as an indicator of SAH was 3.3%. CONCLUSIONS: CSF spectrophotometry has an unacceptably low specificity and positive predictive value, which greatly limit its use as a clinical tool.     

Computed tomography in aneurysmal subarachnoid haemorrhage.

The initial CT scans of 76 patients with aneurysmal subarachnoid haemorrhage were reviewed, and the amount of blood visible in the basal CSF cisterns was quantified. The outcome of surgery was found to correlate significantly with the quantity of blood seen on the scan, as did the pre-operative grade of the patient, a history of pre-existing hypertension, and the presence of angiographic vasospasm.