Rare case of Terson’s syndrome and viral retinitis due to dengue haemorrhagic fever in an infant

Dengue haemorrhagic fever with consequent thrombocytopaenia can lead to intracranial haemorrhage and Terson’s syndrome that can lead to visual problems. Simultaneously, the dengue virus can cause typical viral retinitis like picture in the eye. Early funduscopy and vision assessment is desirable in all dengue patients. In our case, an infant with dengue haemorrhagic fever and intracranial haemorrhage developed not only simultaneous bilateral vitreous and subinternal limiting membrane haemorrhage due to Terson’s syndrome from the indirect effect of thrombocytopaenia but also typical chorioretinitis possibly due to the direct effect of the virus on the retina. The vitreoretinal surgical outcome was satisfactory in this case.

A Case of Terson-Like Syndrome in a Patient with Viral Meningoencephalitis

The proposed mechanism of Terson’s syndrome is increased intracranial pressure that leads to dilation of the retrobulbar optic nerve and compression of the central retinal vein. Terson’s syndrome has been associated with many conditions that increase intracranial pressure such as venous sinus thrombosis, Moyamoya disease, leukemia, direct head trauma, and intraocular hemorrhage related to shaken baby syndrome. We present a novel case of a patient with recent viral prodrome found to have papilledema and multilayered retinal hemorrhages consistent with Terson syndrome. Computed tomography and magnetic resonance venography of the brain did not reveal any subdural, subarachnoid, or intracranial hemorrhages. However, cerebrospinal fluid analyses were significant for increased opening pressure and elevated protein levels, which were suggestive of viral meningoencephalitis. We describe this case as a Terson-like syndrome because the etiology of intraocular hemorrhage is increased intracranial pressure. However, this case does not fit the traditional presentation of Terson’s syndrome as the intracranial pressure is secondary to meningeal inflammation instead of subdural, subarachnoid, or intracranial hemorrhage. We strongly feel that it is important for physicians to be aware of the link between viral meningoencephalitis and retinal conditions such as Terson-like syndrome because it can facilitate rapid diagnosis and treatment.