以急性眼底出血為臨床表徵之自發性顱內出血：病例報告

Acute Fundal Hemorrhage as Presenting Clinical Sign of Spontaneous Intracranial Hemorrhage: Case Report

陳建壬(Chien-Ren Chen) ； 劉光洪(Kuang-Hung Liu) ； 郭淑純(Shu-Chun Kuo) ； 蔡武甫(Wu-Fu Tsai)

《中華民國眼科醫學會雜誌》 42卷2期 (2003/06) Pp. 161-166

https://doi.org/10.30048/ACTASOS.200306.0010

摘要

目的：本文報告一以眼底出血為初期臨床表徵之自發性顱內出血之病例。
方法：病例報告
結果：少數顱內出血可併發視網膜及玻璃體出血，此乃眾所週知之Terson氏症候群。因此症以腦部出血先發生，故多以頭痛、嘔吐、肢體麻痺等神經學症狀為初期表徵。我們報告一位48歲女性，除輕度高血壓外，無特殊病史，主訴左眼視力迅速惡化，而至眼科急診。雖然病人無神經學症狀，但根據眼底檢查特殊之表現，高度懷疑為自發性顱內出血併發之Terson氏症候群，經電腦斷層及血管攝影檢查，確定診斷為大腦動脈瘤破裂併硬腦膜及蜘蛛膜下腔出血。轉介神經外科，經緊急開顱手術後，患者無生命危險。
結論：少數顱內出血早期並無明顯神經學症狀，而眼底出血之特殊外觀，反而可能成為其最早期徵象。當此狀況下，眼科醫師若能高度警覺並予以適當的檢查及轉介，可以早期診斷並緊急處置可能致命之顱內出血。

並列摘要

Purpose: To report on a patient with acute fundal hemorrhage as the initial clinical sign of a spontaneous intracranial hemorrhage.
Method: Case report
Result: Retinal and vitreous hemorrhage associated with intracranial hemorrhage is well known as Terson's syndrome. Neurological symptoms such as headache, vomiting or limbs paralysis are usually as the initial clinical signs due to preceding intracranial hemorrhage. We report a 48 year-old female who came to our ophthalmic emergency room with the chief complaint of rapidly deteriorated vision in her left eye. No other significant medical history except mild hypertension can be traced. Although no any neurological symptom, Terson's syndrome associated with spontaneous intracranial hemorrhage was highly suspected according to the characteristic appearance of fundal hemorrhage. Cranial computed tomography and angiography revealed a subdural and subarachnoid hemorrhage originating from a ruptured cerebral aneurysm. Emergent craniotomy was performed after transferring to Neurosurgery Department. The eventually life-threatening condition got relief
Conclusion: Unusually, there are no significant neurological symptoms in the early stage of intracranial hemorrhage. Under this condition, the ophthalmologists should always keep in mild that the characteristic appearance of fundal hemorrhage may be the first clinical sign of intracranial hemorrhage. Thus, the eventually life-threatening intracranial hemorrhage can be early diagnosed and intervented if we keep alert with such an unusual condition.

並列關鍵字

Terson's syndrome ； Intracranial hemorrhage ； Fundal hemorrhage