Terson’s syndrome following epidural saline injection

Abstract

Terson’s syndrome refers to vitreous hemorrhage after intracranial hemorrhage, often from rupture of an aneurysm. The source of vitreous blood has never been established conclusively. Blood may track along the subarachnoid space of the optic nerve sheath and enter the vitreous cavity through the optic nervehead. Alternatively, the sudden spike in intracranial pressure may burst retinal vessels. We describe a rare case of vitreous hemorrhage after epidural saline injection that offers a clue to the origin of the vitreous blood in Terson’s syndrome. A 39-year-old telephone dispatcher developed chronic low back pain that could not be relieved by physical therapy. She was treated with a series of lumbar epidural steroid injections over a 6-month period. An inadvertent dural puncture occurred, giving rise to a persistent postdural puncture headache. After bedrest, analgesics, and oral hydration failed to bring relief, she was treated with two lumbar epidural blood patches, which were also ineffective. She was then offered epidural saline infusion. The procedure was performed by …