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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 examination of a vitreous haemorrhage (VH) in the left eye.In this case Terson's syndrome appeared as a hyperechogenic membrane caused by clotted blood within the vitreous body. According to Fig. 1 iris and ciliary bodies (4) as well as the anterior (3) and posterior reflection (5) of the lens and the optic nerve (7) are visible.
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pone-0114907-g002: Ocular ultrasound examination of a vitreous haemorrhage (VH) in the left eye.In this case Terson's syndrome appeared as a hyperechogenic membrane caused by clotted blood within the vitreous body. According to Fig. 1 iris and ciliary bodies (4) as well as the anterior (3) and posterior reflection (5) of the lens and the optic nerve (7) are visible.

Mentions: Investigator I detected 11 out of 21 IOH (7 vitreous and 4 retinal hemorrhages) with OUS (sensitivity 52.4%, positive predictive value 57.9%), while 75 out of 83 eyes without IOH were stated to have no TS (specificity 90.4%, negative predictive value 88.2%, overall accuracy 82.7%; Fig. 2). In 8 eyes, an IOH was diagnosed by OUS without the existence of TS (false positive) and in 10 eyes a TS was not detected by OUS (false negative). Investigator II was found to have a specificity of 100% (83 out of 83 eyes) with a negative predictive value of 84.7% and a sensitivity of 21.1% (4 out of 19 IOH; 3 vitreous and 1 retinal hemorrhages) with a positive predictive value of 100% (an accuracy of 85.3%).


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 examination of a vitreous haemorrhage (VH) in the left eye.In this case Terson's syndrome appeared as a hyperechogenic membrane caused by clotted blood within the vitreous body. According to Fig. 1 iris and ciliary bodies (4) as well as the anterior (3) and posterior reflection (5) of the lens and the optic nerve (7) are visible.
© Copyright Policy
Related In: Results  -  Collection

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

pone-0114907-g002: Ocular ultrasound examination of a vitreous haemorrhage (VH) in the left eye.In this case Terson's syndrome appeared as a hyperechogenic membrane caused by clotted blood within the vitreous body. According to Fig. 1 iris and ciliary bodies (4) as well as the anterior (3) and posterior reflection (5) of the lens and the optic nerve (7) are visible.
Mentions: Investigator I detected 11 out of 21 IOH (7 vitreous and 4 retinal hemorrhages) with OUS (sensitivity 52.4%, positive predictive value 57.9%), while 75 out of 83 eyes without IOH were stated to have no TS (specificity 90.4%, negative predictive value 88.2%, overall accuracy 82.7%; Fig. 2). In 8 eyes, an IOH was diagnosed by OUS without the existence of TS (false positive) and in 10 eyes a TS was not detected by OUS (false negative). Investigator II was found to have a specificity of 100% (83 out of 83 eyes) with a negative predictive value of 84.7% and a sensitivity of 21.1% (4 out of 19 IOH; 3 vitreous and 1 retinal hemorrhages) with a positive predictive value of 100% (an accuracy of 85.3%).

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