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Ocular Findings in Raised Intracranial Pressure: A Case of Terson Syndrome in a 7-Month-Old Infant

Mena, Othon J. MD; Paul, Ian MD; Reichard, R. Ross MD

The American Journal of Forensic Medicine and Pathology: March 2011 - Volume 32 - Issue 1 - p 55-57
doi: 10.1097/PAF.0b013e3181edee5b
Case Reports

We present the case of a 7-month-old female infant who was found crying and limp. She was transported to a hospital where a possible subarachnoid hemorrhage was diagnosed radiologically. Before further studies could be pursued, her condition worsened and she died. The autopsy demonstrated diffuse subarachnoid hemorrhage of the brain and along the spinal cord. The brain, spinal cord, and eyes were retained and examined postfixation. An aneurysm of the middle cerebral artery was identified. Examination of the eyes demonstrated bilateral optic nerve sheath hemorrhage and extensive retinal hemorrhages extending to the ora serrata. A rapid increase in intracranial pressure secondary to subarachnoid hemorrhage following rupture of an aneurysm can result in sequelae similar to those found in inflicted traumatic brain injury. In this case, the rise in intracranial pressure resulted in marked hemorrhage within the optic nerve sheaths as well as intra- and preretinal hemorrhages. Patients with subarachnoid hemorrhage, or other causes of rapidly increased intracranial pressure, may develop ocular hemorrhage (Terson syndrome). This case illustrates the importance of ruling out natural disease before attributing the autopsy findings to trauma, as well as the importance of postmortem fixation of pediatric brains and eyes prior to examination.

From the New Mexico Office of the Medical Investigator, Albuquerque, NM.

Manuscript received September 10, 2008; accepted November 13, 2008.

Reprints: Othon J. Mena, MD, County of San Diego Medical Examiner's Office, 5570 Overland Ave, San Diego, CA 92123. E-mail:

© 2011 Lippincott Williams & Wilkins, Inc.