{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T19:08:04Z","timestamp":1768590484671,"version":"3.49.0"},"reference-count":26,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T00:00:00Z","timestamp":1768521600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"DOI":"10.13039\/501100006356","name":"University of Southern Denmark","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100006356","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Neurosurg Rev"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>\n                    Terson syndrome is defined as intraocular hemorrhage secondary to aneurysmal subarachnoid hemorrhage (aSAH). Despite clinical relevance, it remains under-recognized and is associated with poorer neurological and visual outcomes. Early detection is difficult in critically ill patients unable to report symptoms. We aimed to identify independent predictors and develop a clinically usable risk score for targeted ophthalmologic screening. We conducted a retrospective cohort study of 220 adult aSAH patients admitted to Odense University Hospital (Sept 1, 2018-Jan 21, 2025), of whom 89 underwent ophthalmologic screening. Terson syndrome was defined as any intraocular hemorrhage on examination. Predictors were selected using least absolute shrinkage and selection operator (LASSO) logistic regression, with multivariable analysis and internal validation via bootstrapping. A point-based risk score was derived and compared to a literature-based model using discrimination, calibration, information criteria, and decision curve analysis. Sensitivity analyses included Firth logistic regression and inverse probability weighting. Among 220 patients, 89 (40.5%) were screened; 31 had Terson syndrome (14.1% overall; 34.8% of screened). Three predictors were identified: male sex (OR 10.9), higher Hunt-Hess grade (OR 3.0 per grade), and anterior communicating artery aneurysm (OR 8.6; all\n                    <jats:italic>p<\/jats:italic>\n                    \u2009&lt;\u20090.05). The model demonstrated strong discrimination (AUC 0.862; 95% CI, 0.787\u20130.937), good calibration, and outperformed the literature-based comparator (AUC 0.769). A 0\u20137 point-based score stratified risk from &lt;\u200925% to &gt;\u200980%, with superior net benefit. Sensitivity analyses confirmed robustness. This three-variable model offers a pragmatic tool for early Terson syndrome detection and may reduce preventable visual morbidity through targeted screening.\n                  <\/jats:p>","DOI":"10.1007\/s10143-025-03956-6","type":"journal-article","created":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T06:57:35Z","timestamp":1768546655000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Risk factors to guide Terson syndrome screening after aneurysmal subarachnoid Hemorrhage"],"prefix":"10.1007","volume":"49","author":[{"given":"Ilies","family":"Djebbara","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sune","family":"Munthe","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Troels Halfeld","family":"Nielsen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lejla","family":"Islamagi\u010d","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,1,16]]},"reference":[{"key":"3956_CR1","first-page":"309","volume":"6","author":"De l\u2019h\u00e9morrhagie","year":"1900","unstructured":"De l\u2019h\u00e9morrhagie (1900) Dans Le corps vitr\u00e9 Au cours de l\u2019h\u00e9morrhagie c\u00e9r\u00e9brale. Clin Ophthalmol 6:309\u2013312","journal-title":"Clin Ophthalmol"},{"key":"3956_CR2","unstructured":"LITTEN M Ueber einige vom allgemein-Klinischen standpunkt Aus interessante augenveranderungen. Berl Klin Wochenschr. 1881;18:23\u201327"},{"key":"3956_CR3","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2021.107008","volume":"210","author":"R Aboulhosn","year":"2021","unstructured":"Aboulhosn R, Raju B, Jumah F, Majmundar N, Prenner J, Matin T et al (2021) Terson\u2019s syndrome, the current concepts and management strategies: a review of literature. Clin Neurol Neurosurg 210:107008","journal-title":"Clin Neurol Neurosurg"},{"issue":"5","key":"3956_CR4","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1017\/cjn.2014.7","volume":"41","author":"GI Seif","year":"2014","unstructured":"Seif GI, Teichman JC, Reddy K, Martin C, Rodriguez AR (2014) Incidence, morbidity, and mortality of Terson syndrome in Hamilton, Ontario. Can J Neurol Sci J Can Sci Neurol 41(5):572\u2013576","journal-title":"Can J Neurol Sci J Can Sci Neurol"},{"issue":"6","key":"3956_CR5","doi-asserted-by":"publisher","first-page":"1027","DOI":"10.1007\/s00701-016-2766-8","volume":"158","author":"H Joswig","year":"2016","unstructured":"Joswig H, Epprecht L, Valmaggia C, Leschka S, Hildebrandt G, Fournier JY et al (2016) Terson syndrome in aneurysmal subarachnoid hemorrhage\u2014its relation to intracranial pressure, admission factors, and clinical outcome. Acta Neurochir (Wien) 158(6):1027\u20131036","journal-title":"Acta Neurochir (Wien)"},{"issue":"3","key":"3956_CR6","doi-asserted-by":"publisher","first-page":"439","DOI":"10.3171\/JNS\/2008\/109\/9\/0439","volume":"109","author":"KN Fountas","year":"2008","unstructured":"Fountas KN, Kapsalaki EZ, Lee GP, Machinis TG, Grigorian AA, Robinson JS et al (2008) Terson hemorrhage in patients suffering aneurysmal subarachnoid hemorrhage: predisposing factors and prognostic significance. J Neurosurg 109(3):439\u201344","journal-title":"J Neurosurg"},{"issue":"5","key":"3956_CR7","doi-asserted-by":"publisher","first-page":"1172","DOI":"10.3171\/2014.2.JNS131248","volume":"120","author":"E Koskela","year":"2014","unstructured":"Koskela E, Pekkola J, Kivisaari R, Kivel\u00e4 T, Hernesniemi J, Set\u00e4l\u00e4 K et al (2014) Comparison of CT and clinical findings of Terson\u2019s syndrome in 121 patients: a 1-year prospective study. J Neurosurg 120(5):1172\u20138","journal-title":"J Neurosurg"},{"issue":"1","key":"3956_CR8","doi-asserted-by":"publisher","first-page":"97","DOI":"10.3109\/02713683.2012.715713","volume":"38","author":"LN Wu","year":"2013","unstructured":"Wu LN, He T, Xing YQ, Shen Y (2013) Incidence of terson\u2019s syndrome in patients with SAH in a Chinese hospital. Curr Eye Res 38(1):97\u2013101","journal-title":"Curr Eye Res"},{"issue":"2","key":"3956_CR9","doi-asserted-by":"publisher","first-page":"99","DOI":"10.18700\/jnc.170026","volume":"10","author":"MS Choi","year":"2017","unstructured":"Choi MS, Lee JH, Song JH, Lim YC (2017) Prognostic factors affecting visual recovery in Terson syndrome with aneurysmal subarachnoid hemorrhage. J Neurocrit Care 10(2):99\u2013106","journal-title":"J Neurocrit Care"},{"key":"3956_CR10","doi-asserted-by":"publisher","first-page":"182","DOI":"10.1016\/j.jocn.2016.04.015","volume":"33","author":"P Czorlich","year":"2016","unstructured":"Czorlich P, Skevas C, Knospe V, Vettorazzi E, Westphal M, Regelsberger J (2016) Terson\u2019s syndrome \u2013 pathophysiologic considerations of an underestimated concomitant disease in aneurysmal subarachnoid hemorrhage. J Clin Neurosci 33:182\u2013186","journal-title":"J Clin Neurosci"},{"key":"3956_CR11","doi-asserted-by":"crossref","unstructured":"Lima-Fontes M, Leuzinger-Dias M, Rodrigues R, Barros-Pereira R, Falc\u00e3o M, Fernandes V et al Terson Syndrome \u2013 Clinical Presentation, Management, and visual outcomes in a tertiary centre. Clin Ophthalmol 2023;Volume 17:351\u2013359","DOI":"10.2147\/OPTH.S396781"},{"issue":"3","key":"3956_CR12","doi-asserted-by":"publisher","first-page":"371","DOI":"10.3390\/diagnostics15030371","volume":"15","author":"J Kim","year":"2025","unstructured":"Kim J, Han BS, Ha JE, Park MS, Kwon S, Cho BJ (2025) Prediction of the cause of fundus-obscuring vitreous hemorrhage using machine learning. Diagnostics 15(3):371","journal-title":"Diagnostics"},{"issue":"1","key":"3956_CR13","doi-asserted-by":"publisher","first-page":"155","DOI":"10.1007\/s12028-023-01701-9","volume":"39","author":"J G\u00f6ttsche","year":"2023","unstructured":"G\u00f6ttsche J, Knospe V, Sauvigny T, Schweingruber N, Grensemann J, Spitzer MS et al (2023) Terson syndrome in patients with aneurysmal subarachnoid hemorrhage: a 10-year single-center experience. Neurocrit Care 39(1):155\u2013161","journal-title":"Neurocrit Care"},{"issue":"3","key":"3956_CR14","doi-asserted-by":"publisher","first-page":"203","DOI":"10.7461\/jcen.2015.17.3.203","volume":"17","author":"GI Lee","year":"2015","unstructured":"Lee GI, Choi KS, Han MH, Byoun HS, Yi HJ, Lee BR (2015) Practical incidence and risk factors of terson\u2019s syndrome: a retrospective analysis in 322 consecutive patients with aneurysmal subarachnoid hemorrhage. J Cerebrovasc Endovasc Neurosurg 17(3):203","journal-title":"J Cerebrovasc Endovasc Neurosurg"},{"issue":"1","key":"3956_CR15","doi-asserted-by":"publisher","first-page":"19048","DOI":"10.1038\/s41598-019-55566-0","volume":"9","author":"EH Hong","year":"2019","unstructured":"Hong EH, Seong M, Yeom H, Choi S, Choi KS, Kang MH et al (2019) Incidence of Terson syndrome in treated subarachnoid hemorrhage in South korea: a National health insurance database study. Sci Rep 9(1):19048","journal-title":"Sci Rep"},{"key":"3956_CR16","doi-asserted-by":"crossref","unstructured":"Al-Shalchy AK, Al-Wassiti AS Intracranial Aneurysm Predisposing to Terson\u2019s Syndrome: Insights From a Systematic Review. Cureus [Internet]. 2025 May 26 [cited 2025 Jun 5]; Available from: https:\/\/www.cureus.com\/articles\/359635-intracranial-aneurysm-predisposing-to-tersons-syndrome-insights-from-a-systematic-review","DOI":"10.7759\/cureus.84828"},{"issue":"2","key":"3956_CR17","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1111\/j.1755-3768.2008.01200.x","volume":"87","author":"JG Garweg","year":"2009","unstructured":"Garweg JG, Koerner F (2009) Outcome indicators for vitrectomy in Terson syndrome. Acta Ophthalmol (Copenh) 87(2):222\u2013226","journal-title":"Acta Ophthalmol (Copenh)"},{"issue":"3","key":"3956_CR18","doi-asserted-by":"publisher","first-page":"491","DOI":"10.1136\/jnnp.2003.016816","volume":"75","author":"MO McCarron","year":"2004","unstructured":"McCarron MO (2004) A systematic review of terson\u2019s syndrome: frequency and prognosis after subarachnoid haemorrhage. J Neurol Neurosurg Psychiatry 75(3):491\u2013493","journal-title":"J Neurol Neurosurg Psychiatry"},{"issue":"9","key":"3956_CR19","doi-asserted-by":"publisher","first-page":"859","DOI":"10.1007\/s00417-005-1131-z","volume":"243","author":"T Ne\u00df","year":"2005","unstructured":"Ne\u00df T, Janknecht P, Berghorn C (2005) Frequency of ocular hemorrhages in patients with subarachnoidal hemorrhage. Graefes Arch Clin Exp Ophthalmol 243(9):859\u2013862","journal-title":"Graefes Arch Clin Exp Ophthalmol"},{"issue":"5","key":"3956_CR20","doi-asserted-by":"publisher","first-page":"851","DOI":"10.3171\/jns.1998.88.5.0851","volume":"88","author":"RJ Medele","year":"1998","unstructured":"Medele RJ, Stummer W, Mueller AJ, Steiger HJ, Reulen HJ (1998) Terson\u2019s syndrome in subarachnoid hemorrhage and severe brain injury accompanied by acutely raised intracranial pressure. J Neurosurg 88(5):851\u2013854","journal-title":"J Neurosurg"},{"issue":"3","key":"3956_CR21","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1161\/STROKEAHA.108.191395","volume":"40","author":"JB Bederson","year":"2009","unstructured":"Bederson JB, Connolly ES, Batjer HH, Dacey RG, Dion JE, Diringer MN et al (2009) Guidelines for the management of aneurysmal subarachnoid hemorrhage: a statement for healthcare professionals from a special writing group of the stroke Council, American heart association. Stroke 40(3):994\u20131025","journal-title":"Stroke"},{"issue":"6","key":"3956_CR22","doi-asserted-by":"publisher","first-page":"861","DOI":"10.1017\/S031716710005157X","volume":"37","author":"F Paquette","year":"2010","unstructured":"Paquette F, Darsaut TE, Sebag M, Weill A (2010) Terson\u2019s syndrome. Can J Neurol Sci 37(6):861\u2013862","journal-title":"Can J Neurol Sci"},{"issue":"2","key":"3956_CR23","doi-asserted-by":"publisher","first-page":"624","DOI":"10.1161\/STROKEAHA.121.037147","volume":"53","author":"AM Fuentes","year":"2022","unstructured":"Fuentes AM, Stone McGuire L, Amin-Hanjani S (2022) Sex differences in cerebral aneurysms and subarachnoid hemorrhage. Stroke 53(2):624\u2013633","journal-title":"Stroke"},{"key":"3956_CR24","doi-asserted-by":"publisher","first-page":"791547","DOI":"10.3389\/fneur.2022.791547","volume":"13","author":"P Hu","year":"2022","unstructured":"Hu P, Liu Y, Li Y, Guo G, Su Z, Gao X et al (2022) A comparison of LASSO regression and tree-based models for delayed cerebral ischemia in elderly patients with subarachnoid hemorrhage. Front Neurol 13:791547","journal-title":"Front Neurol"},{"key":"3956_CR25","doi-asserted-by":"publisher","first-page":"1390117","DOI":"10.3389\/fnins.2024.1390117","volume":"18","author":"N Li","year":"2024","unstructured":"Li N, Li YL, Shao JM, Wang CH, Li SB, Jiang Y (2024) Optimizing early neurological deterioration prediction in acute ischemic stroke patients following intravenous thrombolysis: a LASSO regression model approach. Front Neurosci 18:1390117","journal-title":"Front Neurosci"},{"issue":"12","key":"3956_CR26","doi-asserted-by":"publisher","first-page":"e114907","DOI":"10.1371\/journal.pone.0114907","volume":"9","author":"P Czorlich","year":"2014","unstructured":"Czorlich P, Burkhardt T, Knospe V, Richard G, Vettorazzi E, Wagenfeld L et al (2014) D Vavvas editor Ocular ultrasound as an easy applicable tool for detection of terson\u2019s syndrome after aneurysmal subarachnoid hemorrhage. PLoS ONE 9 12 e114907","journal-title":"PLoS ONE"}],"container-title":["Neurosurgical Review"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03956-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s10143-025-03956-6","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s10143-025-03956-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T06:57:42Z","timestamp":1768546662000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s10143-025-03956-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,16]]},"references-count":26,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["3956"],"URL":"https:\/\/doi.org\/10.1007\/s10143-025-03956-6","relation":{},"ISSN":["1437-2320"],"issn-type":[{"value":"1437-2320","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,16]]},"assertion":[{"value":"30 June 2025","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"2 October 2025","order":2,"name":"revised","label":"Revised","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"9 November 2025","order":3,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"16 January 2026","order":4,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted as a retrospective observational study. Approval to access and process patient data for research purposes was obtained from the Regional Council (Regionsr\u00e5det). The Regional Council granted permission to perform the study based on the retrospective design and in accordance with applicable regional and national regulations. All data were handled in compliance with data protection legislation, and no direct patient contact or intervention was involved.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent to publish"}},{"value":"Not applicable.","order":5,"name":"Ethics","group":{"name":"EthicsHeading","label":"Clinical trial registration"}},{"value":"The authors declare no competing interests.","order":6,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"130"}}