Unilateral Intravitreal Hemorrhage after Methamphetamine (Pervitin) Overdose in a 16-year-old Boy: a Variant of the Terson’s Syndrome – a Case Report

Czech version

Authors: D. Darsová; P. Pochop; J. Štěpánková; D. Dotřelová
Authors‘ workplace: Oční klinika dětí a dospělých 2. LF UK a FN v Motole, Praha
Published in: Cesk Slov Neurol N 2011; 74/107(3): 344-347
Category: Case Report

Overview

The authors record a rare case of hypertensis crisis complicated by stroke, intracranial haemorrhage and unilateral intraocular haemorrhage after methamphetamine (pervitin) overdose in a 16-year-old boy had led to a hypertensive crisis giving rise to Terson’s syndrome: intracranial haemorrhage, elevation of intracranial pressure and subsequent unilateral intraocular haemorrhage. In the course of 19 days of intensive care with artificial pulmonary ventilation, the intracranial pressure oscillated between 20 and 40 mmHg, central left hemiparesis occurred and right-side intravitreal haemorrhage was diagnosed by an ophthalmologist. After three months of insufficient spontaneous resorption of intravitreal haemorrhage, we performed pars plana vitrectomy (PPV). Visual acuity in the right eye improved after surgery from 6/24 to 6/9. With modern intensive care and optimal timing of PPV, Terson’s syndrome should be recognized as a reversible cause of blindness in patients surviving intracranial haemorrhage.

Key words:
stroke – intracranial haemorrhage – methamphetamine – pars plana vitrectomy – pervitin – retinal sub-inner limiting membrane haemorrhage – Terson’s syndrome – intravitreal haemorrhage

Sources

1. Schloff S, Mullaney PB, Armstrong DC, Simantirakis E, Humphreys RP, Myseros JS et al. Retinal findings in children with intracranial hemorrhage. Am J Ophthalmol 2002; 109(8): 1472–1476.

2. Elner VM. Ocular manifestations of child abuse. Arch Ophthalmol 2008; 126(8): 1141–1142.

3. North Metro Task Force. Methamphetamine [online]. Dostupné z URL: http://www.nmtf.us/methamphetamine/methamphetamine.htm

4. Monshizadeh R, Bhatti MT, Levine L, Tabandeh H. Photodisruption of dense preretinal hemorrhage with Nd:YAG in a child with Terson’s syndrome. J AAPOS 2002; 6(1): 56–58.

5. De Maeyer K, Van Ginderdeuren R, Postelmans L, Stalmans P, Van Calster J. Sub-inner limiting membrane haemorrhage: causes and treatment with vitrectomy. Br J Ophthalmol 2007; 91(7): 869–872.

6. Hlozanek M, Dotrelova D, Vrabcova TL, Osmera J. Nd:YAG laser membranotomy treatment of premacular hemorrhage in two children with hematologic disease. Eur J Ophthalmol 2006; 16(3): 478–480.