Teaching NeuroImages: Terson syndrome in cortical venous sinus thrombosis

An 18-year-old woman presented with headache, right focal seizures, and diminished vision in the left eye for 20 days. Fundus examination revealed bilateral papilledema with large premacular sub–internal limiting membrane and subhyaloid bleeding in the left eye (figure 1A). MRI brain showed hemorrhagic infarct in the left temporal lobe (figure 2, A and B). Magnetic resonance venography showed left transverse and sigmoid sinus thrombosis (figure 2C). A diagnosis of Terson syndrome¹ (vitreous hemorrhage) was made. Procoagulant workup was negative and the patient improved with conservative management² (figure 1B). Even though Terson syndrome has been reported with subarachnoid hemorrhage, its occurrence with cortical venous sinus thrombosis is rare.

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Figure 1 Baseline and follow-up fundus photograph

(A) Baseline fundus photograph shows large premacular sub–internal limiting membrane and subhyaloid bleed in left eye. (B) Follow-up (1 month) fundus photograph shows substantial resolution.

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Figure 2 Gadolinium-enhanced MRI brain and magnetic resonance venography

MRI brain (noncontrast T1-weighted sequence) shows (A) acute left temporal hemorrhagic infarct and (B) filling defect in the superior sagittal sinus (arrow) on gadolinium-enhanced T1 sequence. (C) Magnetic resonance venography shows left-sided sigmoid and transverse sinus thrombosis.

• © 2013 American Academy of Neurology