Purpose: To report a first case of Terson-like syndrome associated with asphyxiophilic practices in an adolescent.
Methods: A 12-year-old boy was referred for decreased visual acuity in his right eye. His father had been diagnosed 3 weeks before with subarachnoidal hemorrhage. Fundus examination showed a dense preretinal hemorrhage in the right eye suggestive of Terson syndrome.
Results: Angio-magnetic resonance imaging eliminated aneurysm and arteriovenous malformation from the diagnosis. After questioning the boy further, he reported that he had participated in the "scarf game", a very popular (but lethal) asphyxiophilic practice in middle school, some hours before he noticed a sharp drop in the visual acuity of his right eye. After 2 months of follow-up, he recovered 20/20 vision in his right eye.
Conclusion: Retinal hemorrhages are quite rare in children. When the cause is not clear (subarachnoidal hemorrhage, arteriovenous malformation, shaken baby syndrome), it must be determined whether the patient has participated in the asphyxiophilic "scarf game" in order to prevent its lethal consequences.