Subhyaloid hemorrhage

Contents • 1 Disease Entity • 1.1 Disease • 1.2 Epidemiology • 1.3 Pathogenesis • 1.4 Etiology • 1.5 Relationship to aneurysm site • 1.6 Clinical presentation • 1.7 Relationship to neurologic outcomes • 2 Diagnosis • 2.1 Complications • 3 Management • 3.1 Treatment and prognosis • 4 References Disease Entity Disease Terson syndrome is now recognized as intraocular hemorrhage associated with SAH, intracerebral hemorrhage, or traumatic brain injury Epidemiology Terson syndrome has been reported in 8-19.3% of SAH Terson syndrome usually occurs in adults, but has been reported in children as young as 7 months Pathogenesis There are several possible pathophysiologic mechanisms for Terson syndrome. Subarachnoid blood may be directly transmitted forward through the optic nerve sheath Etiology Terson syndrome has been reported to be associated with multiple conditions that sustain a spike in intracranial pressure. These causes include carotid artery occlusion, cortical venous sinus thrombosis Relationship to aneurysm site There is conflicting data on aneurysm site in SAH and Terson syndrome. Fountas found that anterior circulation aneurysms are more likely to be associated with Terson syndrome Clinical presentation Terson syndrome can present with dome-shaped hemorrhages in the macula Although intraocular hemorrhages most frequently develop in the first hour after SAH Relationship to neurologic outcomes Low Glasgow coma scale, high Hunt and Hesse grade, and high Fisher grade are a...

Click to view larger Figure 1. Fundus examination of patient's right eye revealed a donut-shaped subhyaloidal hemorrhage in the macula, a preretinal hemorrhage at the superior arcade, a flame-shaped peripapillary hemorrhage, and an inferior vitreous hemorrhage. On ocular examination, both anterior segments and the left fundus were normal. Right fundus examination revealed a donut-shaped subhyaloidal hemorrhage in the macula, a preretinal hemorrhage at the superior arcade, a flame-shaped peripapillary hemorrhage, and an inferior vitreous hemorrhage (Figure 1). The diagnosis was thought to be Valsalva retinopathy, despite the patient's assertion. 1 Interestingly, the fovea was spared by the subhyaloidal hemorrhage, allowing maintenance of good vision. This can be explained by the typical distribution of vitreomacular adhesion in people in this age group. The posterior vitreous is most adherent at the fovea, the optic disc, and around the arcades, whereas it is less adherent in the mid-macula. The relatively weaker adhesions provided a cleavage plane for the blood to spread in a donut shape, sparing the fovea. The distribution of the subhyaloidal hemorrhage, as well as a stage 1 posterior vitreous detachment, 2 were confirmed on OCT (Figure 2). Click to view larger Figure 3. At 1 month, the patient's fundus examination was unremarkable. Observation was recommended. At the 1-month follow-up visit, the fundus appearance had returned to normal, with mild residual inferior vitreo...

Article: • • • • Images: • • Clinical presentation PVD is the most common cause of sudden onset "floaters" in one's visual field, most correctly referred to as "vitreous condensations" in this context. It also may cause Radiographic features Ultrasound The sonographic appearance of isolated posterior vitreous detachment includes the following characteristics 3: • linear, echogenic membrane in the posterior compartment • thickening may be observed in the presence of hemorrhage or inflammation • may demonstrate tethering near the • point of attachment referred to as the vitreous base • freely mobile with oculokinetic ultrasonography 2 • unlike retinal detachment, the membrane will cross the intersection of the optic nerve sheath and posterior wall of the globe • in the acute stages, PVD should demonstrate prominent "after movements" that are more prominent than what would be expected from retinal/choroidal detachments 4 • mobility may be lost over time, making the differentiation from other vitreous pathologies difficult • may be associated with other pathologic findings, including; • retinal detachment • vitreous hemorrhage ​Differential diagnosis • • • • • 1. Paul Riordan-Eva, Emmett Cunningham. Vaughan & Asbury's General Ophthalmology, 18th Edition. (2011) • 2. De La Hoz Polo M, Torramilans Lluís A, Pozuelo Segura O, Anguera Bosque A, Esmerado Appiani C, Caminal Mitjana JM. Ocular ultrasonography focused on the posterior eye segment: what radiologists should know. (2016) ...

AMA Citation Effron D, Forcier BC, Wyszynski RE. Effron D, & Forcier B.C., & Wyszynski R.E. Effron, David, et al.Subhyaloid Hemorrhage in Subarachnoid Hemorrhage. In: Knoop KJ, Stack LB, Storrow AB, Thurman R. Knoop K.J., & Stack L.B., & Storrow A.B., & Thurman R(Eds.), Eds. Kevin J. Knoop, et al.eds. The Atlas of Emergency Medicine, 5e. McGraw Hill; 2021. Accessed June 15, 2023. https://accessmedicine.mhmedical.com/content.aspx?bookid=2969§ionid=250454643 APA Citation Effron D, Forcier BC, Wyszynski RE. Effron D, & Forcier B.C., & Wyszynski R.E. Effron, David, et al. (2021). Subhyaloid hemorrhage in subarachnoid hemorrhage. Knoop KJ, Stack LB, Storrow AB, Thurman R. Knoop K.J., & Stack L.B., & Storrow A.B., & Thurman R(Eds.), Eds. Kevin J. Knoop, et al. The Atlas of Emergency Medicine, 5e. McGraw Hill. https://accessmedicine.mhmedical.com/content.aspx?bookid=2969§ionid=250454643 MLA Citation Effron D, Forcier BC, Wyszynski RE. Effron D, & Forcier B.C., & Wyszynski R.E. Effron, David, et al. "Subhyaloid Hemorrhage in Subarachnoid Hemorrhage." The Atlas of Emergency Medicine, 5e Knoop KJ, Stack LB, Storrow AB, Thurman R. Knoop K.J., & Stack L.B., & Storrow A.B., & Thurman R(Eds.), Eds. Kevin J. Knoop, et al. McGraw Hill, 2021, https://accessmedicine.mhmedical.com/content.aspx?bookid=2969§ionid=250454643. Subhyaloid hemorrhage appears as extravasated blood beneath the retinal layer. These are often described as “boat-shaped” hemorrhages to distinguish them from t...