ATYPICAL PRESENTATION OF TERSON'S SYNDROME FOLLOWING SPINAL ANAESTHESIA­A CASE REPORT

Abstract

A 30 years old female with anal fissure posted for lateral sphinterotomy under spinal anaesthesia.The surgical procedure proceeded uneventfully.In the 12th post operative hour patient had one episode of seizure, disorientation and neck rigidity on examination(suggestive of meningeal               irritation). Electrolyte imbalance was ruled out. Neurological assessment showed no deficit. fundus showed clear media with disc hemorrhages and superior and nasal pole vessels             -venous dilation with intra retinal hemorrhages present in the posterior pole in the paramacular region and pre retinal                hemorrhages in superior and nasal to disc and inferior              quadrant. Right fundus showed clear media with superior pole hemorrhage and vessels-venous dilation in the disc with intra retinal hemorrhages in the posterior pole in the para macular area and pre retinal hemorrhages superior to disc and inferior quadrant.Once weekly follow up of the patient showed these hemorrhages to be resolving. By the end of 7 to 8 weeks most of the intra retinal hemorrhages had cleared with clinically normal disc and vessels.Tersons syndrome is retinal pre    retinal hemorrhages occurring secondary to subarachnoid hemorrhage or raised intra cranial pressure.Having ruled out intracranial bleed infection and other likely systemic causes for intra ocular bleed we would like to consider spinal               anaesthesia as the cause for bilateral retinal hemorrhage.