Intraocular and optic nerve sheath hemorrhage in cases of sudden intracranial hypertension

Abstract

✓ The eyes of 23 patients with sudden intracranial hypertension were studied at post-mortem. Intraocular hemorrhage had occurred in 37% and optic nerve sheath hemorrhage in 87%. Expansion of the optic nerve sheath, particularly the fusiform retrobulbar portion, was a consistent finding. The subdural space of the optic nerve sheath bore the brunt of the hemorrhage which sometimes communicated with perivascular intradural hemorrhages. Optic nerve sheath hemorrhage is shown to result from rupture of dural and bridging vessels of the optic nerve sheath; this we conclude is subsequent to optic nerve sheath dilatation caused by the transmission of intracranial pressure through the subarachnoid communication between the optic nerve sheath and the intracranial cavity. Intraocular hemorrhage is the result of retinal venous hypertension and rupture brought on by obstruction of both the central retinal vein and the retinochoroidal anastomosis.