Subarachnoid hemorrhage-negative Terson syndrome after balloon-assisted coil embolization in a patient with underlying antiphospholipid antibody syndrome.

PURPOSE: To report subarachnoid hemorrhage-negative Terson syndrome after coil embolization of an unruptured intracranial aneurysm in a patient with underlying antiphospholipid syndrome.

METHODS: Retrospective case report. A 48-year-old woman with underlying antiphospholipid syndrome.

RESULTS: Our patient underwent balloon-assisted coil embolization of an unruptured right internal carotid artery aneurysm. There was herniation of the second coil requiring coil retrieval with subsequent nonflow limiting herniation of the first coil left in situ on anticoagulation. In the immediate postprocedure period, she developed preretinal, intraretinal, and vitreous hemorrhages requiring temporary withholding of anticoagulation therapy with careful resumption. Visual acuity was counting fingers and there was an afferent pupillary defect. Two week after discharge, the patient underwent a pars plana vitrectomy for dense breakthrough vitreous hemorrhage. Four weeks after pars plana vitrectomy, her visual acuity was 20/400.

CONCLUSION: Terson syndrome should be considered in a patient with visual symptoms after not only aneurysmal subarachnoid hemorrhage but also non-subarachnoid hemorrhage elective aneurysm coiling as demonstrated by our case.