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Terson Syndrome from Subarachnoid Hemorrhage in Aplastic Anemia

      A 22-year-old woman presented with vision loss after weeks of menorrhagia and a recent fall. Fundoscopic examination showed a multilayered hemorrhage (intraretinal, subinternal limiting membrane, subhyaloid, intravitreal), with a “double-ring” from hemodissection of the internal limiting membrane and subhyaloid space (Fig 1A). Workup revealed pancytopenia and subarachnoid hemorrhage. Bone marrow biopsy showed hypocellular marrow (Fig 1B) with lymphoid cells and rare erythroid elements (Fig 1C), consistent with aplastic anemia. Terson syndrome is an intraocular hemorrhage, often multilayered, associated with intracranial hemorrhage. The pathogenesis is debated but likely related to sudden rises in intracranial pressure, resulting in venous hypertension and rupture of retinal vessels.
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