BMJ Case Reports 2018; doi:10.1136/bcr-2017-222745
  • Unusual association of diseases/symptoms

Blind spot: blindness as initial presentation of subarachnoid haemorrhage

  1. Nuno Ribeiro Ferreira
  1. Department of Medicine, Hospital Beatriz Angelo, Loures, Portugal
  1. Correspondence to Dr André Leonardo Gordinho, aj.leonardogordinho{at}
  • Accepted 27 March 2018
  • Published 10 April 2018


A 47-year-old Caucasian man with arterial hypertension was admitted after a seizure. At the emergency department, he presented with high blood pressure, bilateral vision loss (evidenced by unresponsiveness to threatening stimuli), right hemiplegia and severe agitation. The brain CT angiography showed a diffuse basal cisterns subarachnoid haemorrhage with a ruptured basilar aneurysm. He was admitted for neurovascular procedure and embolisation. The patient’s neurological examination improved but blindness persisted. A funduscopic examination revealed a left eye vitreous haemorrhage and diffuse retinal haemorrhages in the posterior pole. Assuming the haemorrhages were the cause of blindness, Terson syndrome was diagnosed. The patient underwent vitrectomy surgery being discharged 5 days later maintaining left eye blindness and able to count fingers from 1 m distance with the right eye. Two months after discharge, he was re-evaluated at our clinic with left eye blurred vision and almost normal right eye visual acuity.


  • Contributors ALG was involved in data collection regarding the clinical case, planning, drafting, editing, design and final approval of submitted version. SR was involved in data collection regarding the clinical case, editing, revising and final approval of the submitted version. TM and NRF were involved in editing, revising and final approval of the submitted version.

  • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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