Acute vision loss secondary to epidural blood patch: Terson syndrome

Gabriel L. Pagani-Estévez, John Chen, James Watson, Jacqueline A. Leavitt

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Background and Objectives: Lumbar epidural blood patch (EBP) is a commonly used procedure to treat postdural puncture headache. We present a case of vision loss immediately following an EBP. Case Report: A 49-year-old woman with idiopathic intracranial hypertension received an EBP for postdural puncture headache at an outside facility without fluoroscopic guidance and in the seated position. The patient experienced syncope during the procedure as 25 mL of autologous blood was rapidly injected. The patient regained consciousness and described bilateral vision loss. Brain magnetic resonance imaging was negative for hemorrhage. Dilated fundus examination revealed significant, bilateral retinal and vitreous hemorrhage consistent with Terson syndrome. Conclusions: This patient developed Terson syndrome as an immediate EBP complication. Iatrogenic Terson syndrome has been previously described with epidural space saline and anesthetic injections, but not EBP. Of 11 reported cases, 10 were female, and 9 had complete vision recovery. Previous studies have demonstrated that epidural space injection increases subarachnoid pressure in a volume- and rate-dependent fashion. An abrupt increase in subarachnoid space pressure likely led to retinal hemorrhage by compromising retinal venous drainage. This is the first known case of Terson syndrome caused by EBP. Injectate volume should be minimized, and a slow rate of injection pursued. The anesthesiologist, pain interventionist, and ophthalmologist should be aware of this rare but disabling complication and consider taking extra precautions when consenting patients for EBP with vision compromise or comorbidities concerning for elevated intracranial pressure.

Original languageEnglish (US)
Pages (from-to)164-168
Number of pages5
JournalRegional Anesthesia and Pain Medicine
Volume41
Issue number2
DOIs
StatePublished - Jan 1 2016

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Epidural Blood Patch
Post-Dural Puncture Headache
Retinal Hemorrhage
Epidural Space
Intracranial Pressure
Epidural Injections
Pseudotumor Cerebri
Vitreous Hemorrhage
Subarachnoid Space
Injections
Intracranial Hypertension
Syncope
Consciousness
Posture
Anesthetics
Comorbidity
Drainage
Magnetic Resonance Imaging
Hemorrhage
Pain

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

Cite this

Acute vision loss secondary to epidural blood patch : Terson syndrome. / Pagani-Estévez, Gabriel L.; Chen, John; Watson, James; Leavitt, Jacqueline A.

In: Regional Anesthesia and Pain Medicine, Vol. 41, No. 2, 01.01.2016, p. 164-168.

Research output: Contribution to journalArticle

Pagani-Estévez, Gabriel L. ; Chen, John ; Watson, James ; Leavitt, Jacqueline A. / Acute vision loss secondary to epidural blood patch : Terson syndrome. In: Regional Anesthesia and Pain Medicine. 2016 ; Vol. 41, No. 2. pp. 164-168.
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