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Ocular ultrasound as an easy applicable tool for detection of Terson's syndrome after aneurysmal subarachnoid hemorrhage.

Czorlich P, Burkhardt T, Knospe V, Richard G, Vettorazzi E, Wagenfeld L, Westphal M, Regelsberger J, Skevas C - PLoS ONE (2014)

Bottom Line: Fifty-two patients (104 eyes in total) suffering from aneurysmal subarachnoid hemorrhage were enrolled in this study.Indirect funduscopy following iatrogenic mydriasis served as the gold standard for confirmation or exclusion of an intraocular hemorrhage.Positive and negative predictive values were different for both investigators (63.6% vs. 100% positive and 100% vs. 95.7% negative) but were both correlated to the amount of intraocular hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

ABSTRACT

Introduction: Intraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as Terson's syndrome and is an underestimated but common pathology. We therefore designed a prospective single-blinded study to evaluate the validity of ocular ultrasound compared to the gold standard indirect funduscopy in the diagnosis of Terson's syndrome.

Material and methods: Fifty-two patients (104 eyes in total) suffering from aneurysmal subarachnoid hemorrhage were enrolled in this study. Two investigators independently performed a single-blinded ocular ultrasound using a standard intensive care ultrasound system to detect an intraocular hemorrhage. Indirect funduscopy following iatrogenic mydriasis served as the gold standard for confirmation or exclusion of an intraocular hemorrhage. Statistical analyses were performed to evaluate the sensitivity and specificity, positive and negative predictive values of the method as well as the learning curve of ocular ultrasound.

Results: Indirect funduscopy detected Terson's syndrome in 11 of 52 (21.2%) respectively in 21 of 104 (20.2%) eyes in patients suffering from subarachnoid hemorrhage. Sensitivity and specificity increased with the number of ocular ultrasound examinations for both investigators, reaching 81.8% and 100% respectively. Positive and negative predictive values were different for both investigators (63.6% vs. 100% positive and 100% vs. 95.7% negative) but were both correlated to the amount of intraocular hemorrhage. A low Glasgow Coma scale (p = 0.015) and high Hunt & Hess grade (p = 0.003) was associated with a higher rate of Terson's syndrome.

Conclusions: Ocular ultrasound using standard ultrasound equipment has been confirmed as a reliable, easy-to-handle bedside screening tool for detecting Terson's syndrome. Nevertheless funduscopy remains the gold standard to detect Terson's syndrome.

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Related in: MedlinePlus

Ocular Ultrasound of a normal eye.The ultrasound probe is applied to the closed eye and transmission gel used to avoid any pressure on the eye. The normal eye (here right eye) appears as a round hypoechoic (grey-black) structure, and the cornea (2) is a thin hyperechoic (white) layer next to the eyelid (1). This is adjacent to the anterior chamber (hypoechoic water-filled cavity). Below the chamber, a hyperechoic iris and ciliary bodies (4) follow with the anterior (hyperechogenic) reflection of the lens (3). The lens itself is hypoechogenic with a smaller reflection on the rear side (5). The vitreous body is hypoechogenic due to its water-filled cavity. Retina may not be differentiated from choroidal layers, while the optic nerve appears as a hypoechoic linear structure (7) entering the vitreous chamber (6).
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pone-0114907-g001: Ocular Ultrasound of a normal eye.The ultrasound probe is applied to the closed eye and transmission gel used to avoid any pressure on the eye. The normal eye (here right eye) appears as a round hypoechoic (grey-black) structure, and the cornea (2) is a thin hyperechoic (white) layer next to the eyelid (1). This is adjacent to the anterior chamber (hypoechoic water-filled cavity). Below the chamber, a hyperechoic iris and ciliary bodies (4) follow with the anterior (hyperechogenic) reflection of the lens (3). The lens itself is hypoechogenic with a smaller reflection on the rear side (5). The vitreous body is hypoechogenic due to its water-filled cavity. Retina may not be differentiated from choroidal layers, while the optic nerve appears as a hypoechoic linear structure (7) entering the vitreous chamber (6).

Mentions: A standard ultrasound system (General Electrics, Vivid S6; GE 8L-RS, General Electrics Healthcare, Chalfont St Giles, United Kingdom) with high-resolution linear probe (10 MHz) was used to simulate an examination in regular care hospitals outside high specialized medical centers. Standard water-soluble ultrasound transmission gel was applied to the closed eyelid of the patient so that the transducer did not touch the eyelid avoiding any pressure to the ocular bulb. (Fig. 1)


Ocular ultrasound as an easy applicable tool for detection of Terson's syndrome after aneurysmal subarachnoid hemorrhage.

Czorlich P, Burkhardt T, Knospe V, Richard G, Vettorazzi E, Wagenfeld L, Westphal M, Regelsberger J, Skevas C - PLoS ONE (2014)

Ocular Ultrasound of a normal eye.The ultrasound probe is applied to the closed eye and transmission gel used to avoid any pressure on the eye. The normal eye (here right eye) appears as a round hypoechoic (grey-black) structure, and the cornea (2) is a thin hyperechoic (white) layer next to the eyelid (1). This is adjacent to the anterior chamber (hypoechoic water-filled cavity). Below the chamber, a hyperechoic iris and ciliary bodies (4) follow with the anterior (hyperechogenic) reflection of the lens (3). The lens itself is hypoechogenic with a smaller reflection on the rear side (5). The vitreous body is hypoechogenic due to its water-filled cavity. Retina may not be differentiated from choroidal layers, while the optic nerve appears as a hypoechoic linear structure (7) entering the vitreous chamber (6).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4263478&req=5

pone-0114907-g001: Ocular Ultrasound of a normal eye.The ultrasound probe is applied to the closed eye and transmission gel used to avoid any pressure on the eye. The normal eye (here right eye) appears as a round hypoechoic (grey-black) structure, and the cornea (2) is a thin hyperechoic (white) layer next to the eyelid (1). This is adjacent to the anterior chamber (hypoechoic water-filled cavity). Below the chamber, a hyperechoic iris and ciliary bodies (4) follow with the anterior (hyperechogenic) reflection of the lens (3). The lens itself is hypoechogenic with a smaller reflection on the rear side (5). The vitreous body is hypoechogenic due to its water-filled cavity. Retina may not be differentiated from choroidal layers, while the optic nerve appears as a hypoechoic linear structure (7) entering the vitreous chamber (6).
Mentions: A standard ultrasound system (General Electrics, Vivid S6; GE 8L-RS, General Electrics Healthcare, Chalfont St Giles, United Kingdom) with high-resolution linear probe (10 MHz) was used to simulate an examination in regular care hospitals outside high specialized medical centers. Standard water-soluble ultrasound transmission gel was applied to the closed eyelid of the patient so that the transducer did not touch the eyelid avoiding any pressure to the ocular bulb. (Fig. 1)

Bottom Line: Fifty-two patients (104 eyes in total) suffering from aneurysmal subarachnoid hemorrhage were enrolled in this study.Indirect funduscopy following iatrogenic mydriasis served as the gold standard for confirmation or exclusion of an intraocular hemorrhage.Positive and negative predictive values were different for both investigators (63.6% vs. 100% positive and 100% vs. 95.7% negative) but were both correlated to the amount of intraocular hemorrhage.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.

ABSTRACT

Introduction: Intraocular hemorrhage in patients suffering from aneurysmal subarachnoid hemorrhage is known as Terson's syndrome and is an underestimated but common pathology. We therefore designed a prospective single-blinded study to evaluate the validity of ocular ultrasound compared to the gold standard indirect funduscopy in the diagnosis of Terson's syndrome.

Material and methods: Fifty-two patients (104 eyes in total) suffering from aneurysmal subarachnoid hemorrhage were enrolled in this study. Two investigators independently performed a single-blinded ocular ultrasound using a standard intensive care ultrasound system to detect an intraocular hemorrhage. Indirect funduscopy following iatrogenic mydriasis served as the gold standard for confirmation or exclusion of an intraocular hemorrhage. Statistical analyses were performed to evaluate the sensitivity and specificity, positive and negative predictive values of the method as well as the learning curve of ocular ultrasound.

Results: Indirect funduscopy detected Terson's syndrome in 11 of 52 (21.2%) respectively in 21 of 104 (20.2%) eyes in patients suffering from subarachnoid hemorrhage. Sensitivity and specificity increased with the number of ocular ultrasound examinations for both investigators, reaching 81.8% and 100% respectively. Positive and negative predictive values were different for both investigators (63.6% vs. 100% positive and 100% vs. 95.7% negative) but were both correlated to the amount of intraocular hemorrhage. A low Glasgow Coma scale (p = 0.015) and high Hunt & Hess grade (p = 0.003) was associated with a higher rate of Terson's syndrome.

Conclusions: Ocular ultrasound using standard ultrasound equipment has been confirmed as a reliable, easy-to-handle bedside screening tool for detecting Terson's syndrome. Nevertheless funduscopy remains the gold standard to detect Terson's syndrome.

Show MeSH
Related in: MedlinePlus