Skip to main content

Advertisement

SpringerLink
Log in

Late ophthalmological assessment of patients with subarachnoid hemorrhage and clipping of cerebral aneurysm

  • Clinical Article
  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Abstract

Purpose

To estimate prospectively late ocular manifestations in patients after aneurysmal subarachnoid hemorrhage (SAH) treated with aneurysm clipping.

Methods

Forty-six patients (12 men and 34 women), 23–69 years of age, were included in this study. A conventional ophthalmological examination, visual evoked potentials (VEPs), and static perimetry were performed on all patients. The mean interval between the onset of SAH and the aforementioned examination was 1.9 ± 1.3 years (range 0.5-5 years). The following were compared between patients with affected and non-affected visual fields as well as between those with normal and abnormal VEPs: sex, age, time from SAH to surgery, Hunt and Hess scale, Glasgow Coma Scale, Glasgow Outcome Scale, grading of SAH according to the Fisher scale, and the size and site of aneurysm.

Results

Visual field defects were found in 23 patients (50%). In all of these patients, both eyes were affected. The most frequent type of visual field defects were: constricted field (47.8%), multiple peripheral foci (26.1%), and superior field defect (17.4%). There was no significant relationship between the analyzed factors and the occurrence of visual field defects, although statistical significance was almost observed in respect to the Fisher scale (p = 0.055).

Deterioration in VEPs was observed in nine patients (19.6%). In the group of patients with abnormal VEPs, the time from onset of SAH to surgery was 2.6 ± 1.8 days, whereas in the group of patients with normal VEPs this time amounted to 6.4 ± 2.4 days (p = 0.02). In patients with no changes in VEPs, the mean Fisher score was significantly higher than in the group with abnormal VEPs (2.8 ± 0.6 vs 2.0 ± 0.4 respectively, p = 0.04).

Conclusion

Visual field defects and VEP deterioration are frequent late ocular manifestations of SAH treated with aneurysm clipping. Damage to the visual pathway correlates with the severity of SAH and timing of aneurysmal surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Biousse V, Mendicino ME, Kimon DJ, Newman NJ (1998) The ophthalmology of intracranial vascular abnormalities. Am J Ophthalmol 125:527–544

    Article  PubMed  CAS  Google Scholar 

  2. Entezari M, Azhari S, Ramezani A (2009) Fundus findings in spontaneous subarachnoid hemorrhage and their correlation with neurological characteristics. Eur J Ophthalmol 19:460–465

    PubMed  Google Scholar 

  3. Fountas KN, Kapsalaki EZ, Lee GP, Machinis TG, Grigorian AA, Robinson JS, Vergados I, Theodosiadis PG (2008) Terson hemorrhage in patients suffering aneurismal subarachnoid hemorrhage: predisposing factors and prognostic significance. J Neurosurg 109:439–444

    Article  PubMed  Google Scholar 

  4. Frizzell RT, Kuhn F, Morris R, Quinn C, Fisher WS (1997) Screening of ocular hemorrhage in patients with ruptured cerebral aneurysms: a prospective study of 99 patients. Neurosurgery 41:529–533

    PubMed  CAS  Google Scholar 

  5. Garfinkle AM, Danys IR, Nicolle DA, Colohan RT, Brem S (1992) Terson`s syndrome: a reversible cause of blindness following subarachnoid hemorrhage. J Neurosurg 76:766–771

    Article  PubMed  CAS  Google Scholar 

  6. Garweg JG, Koerner F (2009) Outcome indications for vitrectomy in Tersone syndrome. Acta Ophthalmol 87:222–226

    Article  PubMed  Google Scholar 

  7. Hackett ML, Anderson CS (2000) Health outcomes 1 years after subarachnoid hemorrhage: An international population-based study. The Australian cooperative research on subarachnoid hemorrhage study group. Neurology 55:658–662

    PubMed  CAS  Google Scholar 

  8. Hütter BO, Gilsbach JM, Kreitschmann I (1995) Quality of life and cognitive deficits after subarachnoid haemorrhage. Br J Neurosurg 9:465–475

    Article  PubMed  Google Scholar 

  9. Kuhn F, Morris R, Witherspoon D, Mester V (1998) Terson Syndrome. Results of vitrectomy and the significance of vitreous hemorrhage in patients with subarachnoid hemorrhage. Ophthalmology 105:472–477

    Article  PubMed  CAS  Google Scholar 

  10. Litten M (1881) Ueber einige vom allgemeinklinischen Standpunkt aus interessante Augenveränderungen. Berl Klin Wochenschr 18:23–27

    Google Scholar 

  11. Marmor MF, Zrenner E (1999) Standard for clinical electrophysiology (1999 update). International society for clincal electrophysilogy of vision. Doc Ophthalmol 97:143–156

    Article  CAS  Google Scholar 

  12. Neβ T, Janknecht P, Berghorn C (2005) Frequency of ocular hemorrhages in patients with subarachnoid hemorrhage. Graefe`s Arch Clin Exp Ophthalmol 243:859–862

    Article  Google Scholar 

  13. Obuchowska I, Mariak Z, Budrowski R, Mariak Z (2008) Changes in the visual system 6 months after subarachnoid hemorrhage connected with rupture of aneurysm of the base of the brain. Polish J Environ Stud 17(1A):110–114

    Google Scholar 

  14. Pfausler B, Belcl R, Metzler R, Mohsenipour I, Schmutzhard E (1996) Terson`s syndrome in spontaneous subarachnoid hemorrhage: a prospective study in 60 consecutive patients. J Neurosurg 85:392–394

    Article  PubMed  CAS  Google Scholar 

  15. Powell PM, Lichtman SL, Laws ER (2003) Managements of pituitary tumors. Human Press, Totowa

    Book  Google Scholar 

  16. Rhoton AL (2002) The supratentorial arteries. Neurosurgery 51(Suppl 1):S53–S120

    PubMed  Google Scholar 

  17. Ritland JS, Syrdalen P, Eide N, Vatne HO, Øvergaard R (2002) Outcome of vitrectomy in patients with Terson syndrome. Acta Ophthalmol Scan 80:172–174

    Article  Google Scholar 

  18. Schultz PN, Sobol WM, Weingeist TA (1991) Long-term visual outcome in Tersone syndrome. Ophthalmology 98:1814–1819

    PubMed  CAS  Google Scholar 

  19. Sobey CG, Faraci FM (1998) Subarachnoid haemorrhage: what happens to the cerebral arteries. Clin Exp Pharmacol Physiol 25:867–876

    Article  PubMed  CAS  Google Scholar 

  20. Stiebel-Kliash H, Turtel LS, Kupersmith MJ (2004) The natural history of nontraumatic subarachnoid hemorrhage-related intraocular hemorrhage. Retina 24:36–40

    Article  Google Scholar 

Download references

Acknowledgments

This study was supported by Polish Ministry of Science and Higher Education grant N 403 040 32/2157.

Conflicts of interest

None.

Author information

Authors and Affiliations

  1. Department of Ophthalmology, Medical University of Bialystok, ul. Sklodowskiej-Curie 24a, 15-276, Białystok, Poland

    Iwona Obuchowska & Zofia Mariak

  2. Department of Neurosurgery, Medical University of Bialystok, ul. Sklodowskiej-Curie 24a, 15-276, Białystok, Poland

    Grzegorz Turek, Zenon Mariak & Jan Kochanowicz

Authors
  1. Iwona Obuchowska
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Grzegorz Turek
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zenon Mariak
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jan Kochanowicz
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Zofia Mariak
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Iwona Obuchowska.

Additional information

Comment

Patients with SAH have more visual problems than we may recognize as other neurological sequelae may steal the attention initially. But, after the initial recovery, visual problems may disturb daily activities and this has not been well studied in detail in the long run. The current paper shows that visual field defects are quite common after SAH and clipping of aneurysms, but the effects of each can not be separated. We do not know the visual state well enough before the ictus. The paper also addresses the importance of gentle dissection under high magnification of the operating microscope in slack brain using modern neuroanesthesia, preferably without the use of retractors to avoid iatrogenic brain and nerve damage.

There are biases concerning the examination of the patients affecting the results. In cases of constricted visual fields and normal appearing optic nerve heads, you should take into consideration the huge effect of learning: in some patients the first visual field examination is worse than the later ones and these results should be evaluated carefully. Even though you have a commonly accepted automated perimeter and the examination is performed according to a strict standard methodology, many patients cannot cope with the automated static perimetry as it may be too exhaustive for them, with negative effects on the results. In patients with severe visual field defects, kinetic perimetry by a skilled perimetrist should be performed.

Elina Koskela

Kirsi Setälä

Mika Niemelä

Juha Hernesniemi

Helsinki, Finland

Rights and permissions

Reprints and permissions

About this article

Cite this article

Obuchowska, I., Turek, G., Mariak, Z. et al. Late ophthalmological assessment of patients with subarachnoid hemorrhage and clipping of cerebral aneurysm. Acta Neurochir 153, 2127–2136 (2011). https://doi.org/10.1007/s00701-011-1161-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00701-011-1161-8

Keywords

Search

Navigation