Título / Title

TERSON SYNDROME ASSOCIATED WITH THROMBOTIC THROMBOCYTOPENIC PURPURA: A CASE REPORT

Introdução / Purpose

This report aims to describe the case of a patient with Terson Syndrome, related to neurological events and thrombocytopenia.

Material e Método / Methods

Data collection from medical records and test results.

Resultados / Results

S.J.S.C, 52 years old, female, complaining of a red spot in the right eye for 10 days, intense headache, mental confusion and amnesia. Visual acuity counts fingers at 20 cm in the right eye and 20/30-2 in the left eye. Indirect funduscopy showed 4/4+ vitreous hemorrhage in the right eye and a scar of chorioretinitis in the left eye. She was diagnosed with thrombotic thrombocytopenic purpura (platelets of 5,000) and autoimmune encephalitis with associated subarachnoid hemorrhage. Plasmapheresis was started daily and corticosteroids. Returned in 1 month and ultrasound showed vitreous with hemorrhage adhered to the optic nerve, retinography and optical coherence tomography with candle flame hemorrhage, subretinal hemorrhage and macular atrophy, suggestive of Terson Syndrome. Follow-up with corticosteroid regression, and follow-up, with visual improvement in the affected eye, currently counting fingers at 1 meter.

Discussão e Conclusões / Conclusion

The syndrome was described by Albert Terson in 1900, initially as vitreous hemorrhage secondary to subarachnoid hemorrhage, but other publications demonstrate that it can occur due to other bleeding in the central nervous system, such as stroke, traumatic brain injury and aneurysm rupture. The pathophysiology is related to intracerebral hemorrhage and sudden increase in intracranial pressure, which would lead to an increase in the perfusion of cerebrospinal fluid around the optic nerve, which in turn would cause compression, obstruction and stasis of the retinochoroidal and central retinal vein, leading to increased intraocular pressure and consequent vascular rupture and bleeding. Intraocular bleeding may manifest as vitreous, intraretinal, subretinal, or subhyaloid hemorrhage.

Palavras Chave

TERSON SYNDROME

Area

CLINICAL RETINA