In Terson syndrome, vitreous haemorrhage occurs in association with which intracranial event, and through which proposed anatomical mechanism?

• A Ischaemic stroke; cerebral oedema raises ICP transmitting pressure to the optic nerve sheath
• B Subarachnoid haemorrhage; sudden ICP rise transmits along the optic nerve sheath, rupturing retinal or preretinal vessels ✓
• C Traumatic brain injury; fat emboli reach the retinal circulation
• D Bacterial meningitis; septic emboli block the central retinal vein

Explanation

Terson syndrome is defined as intraocular (vitreous, preretinal, or subhyaloid) haemorrhage occurring in the context of subarachnoid haemorrhage (SAH), though it also occurs with other causes of sudden ICP rise (subdural haemorrhage, severe TBI). The mechanism is thought to involve sudden ICP elevation transmitted along the optic nerve sheath to the peripapillary retinal veins, causing their rupture. It occurs in approximately 13-20% of SAH cases and is associated with worse neurological prognosis.

Reference: Khurana Comprehensive Ophthalmology, 7th ed.

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