[Retinal and vitreal hemorrhages in the course of subarachnoid hemorrhages].
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Adolescent↗
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Results for “RETINAL HEMORRHAGE”
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Natural interferon therapy: optic nerve ischemic damage?
The purpose of this study was the evaluation of retinal abnormalities during a treatment with natural interferon (IFN-alpha for chronic hepatitis C. Retinal hemorrhages and optic disk edema were found in a 40-year-old woman during IFN-alpha therapy. The disk edema and retinopathy resolved after the INF was discontinued. Although retinal abnormalities correlated with IFN therapy have been described recently by some authors, the pathogenesis is still unclear. Anterior ischemic optic neuropathy occurring in a patient treated with IFN is a probable complication of the therapy.
Adult↗
Krypton and argon laser photocoagulation effects in subretinal hemorrhage.
Previous studies suggested that krypton laser photocoagulation was more effective in the treatment of macular diseases than argon laser. Furthermore, it could perform photocoagulation more effectively in some lesions with subretinal hemorrhage, because the krypton laser beam was poorly absorbed by hemoglobin. In the present experiment, hemorrhagic retinal detachment was produced in monkey eyes with Q-switched Nd-YAG laser, and 4 weeks later photocoagulation was performed with krypton and argon lasers to compare the differences in the effects of these two lasers. When the subretinal hemorrhage and a heavy coagulation effect was produced in the detached retina, but no coagulation effects were observed in the choroid. Krypton laser beam could go through the hemorrhage and certain coagulation effects were observed in the choroid and the detached retina. It is suggested that krypton laser photocoagulation is more effective in the lesions behind subretinal hemorrhages than photocoagulation with argon laser.
Animals↗
[Vitrectomy for vitreous hemorrhage caused by retinal vein occlusion].
OBJECTIVE: To evaluate the efficacy and complications of vitrectomy for vitreous hemorrhage after retinal vein occlusion. METHODS: We retrospectively studied 47 patients (47 eyes) having undergone vitrectomy during the period from April, 1992 to December, 1996. Follow-up was made on 30 patients. RESULTS: (1) Visual acuity was improved postoperatively in 80% of the eyes. The patients with branch vein occlusion achieved more favorable final vision than those with central retinal vein occlusion (P < 0.05). (2) The most common complications were lens opacity, recurrent vitreous hemorrhage, iatrogenic rhegmatogenous retinal detachment and glaucoma. (3) Patients treated with endophotocoagulation had a lower rate of recurrent vitreous hemorrhage (P < 0.05). CONCLUSIONS: (1) More than half of the patients can achieve ambulant vision after vitrectomy for vitrous hemorrhage induced by retinal vein occlusion. (2) Recurrent vitreous hemorrhage can be effectively prevented by endophotocoagulation during the operation.
Adult↗
Usefulness of postmortem ocular findings in forensic autopsy.
We report three autopsy cases in which the eyeballs were removed and examined macroscopically and microscopically after being cut using the alternate gross examination technique. The first case was a 67-year-old woman who was killed by ligature and manual strangulation. A postmortem opthalmological observation of the left eyeball revealed tiny hemorrhages and congestion in the pars plicae of the ciliary body. These changes were considered to arise by a mechanism similar to that by which facial hemorrhages arise during strangulation. The second case was a 54-year-old man who died from a cerebral contusion received during a traffic accident. A postmortem opthalmological observation of the eyeball using a surgical microscope revealed papilledema and retinal hemorrhages resulting from a rise in intracranial pressure. The third case was a 77-year-old woman who died from cardiac tamponade caused by a stab wound to the heart. A postmortem ophthalmological examination revealed that she had undergone cataract surgery and an intraocular lens implantation. However, her relatives did not know when and where she had received the surgery. An intraocular lens was removed and its material and shape was examined. Based on an examination of the lens, we were able to locate the hospital where she had received the surgery 4 years earlier. This suggests that postmortem opthalmological observations may be useful for forensic pathology and personal identification.
Aged↗
Partial retinal artery occlusion after coil embolization of an intracerebral aneurysm.
Occlusion of the retinal artery is a rare complication after therapeutic embolization. We present a case of a partial retinal artery obstruction following coil embolization of an intracerebral aneurysm. To our knowledge, only six cases of acute occlusion of the choroidal and/or retinal arteries after therapeutic embolization have been reported so far. The case presented here, however, is the first in which platinum microcoils were the material used. In addition the retinal ischemia was reversible, visual acuity returning to normal and cutten-wool spot and retinal hemorrhages resolving spontaneously.
Carotid Artery, Internal↗
Child abuse and sudden infant death syndrome.
Ann Botash reviews the current literature regarding the association of retinal hemorrhage and subarachnoid bleeds in infants who have suffered head trauma. Particular emphasis is placed on differentiating these findings from those in children who suffer other forms of trauma, especially cardiopulmonary resuscitation. The office practitioner needs appropriate skills in performing careful retinal examination and when to refer patients to an ophthalmologist for specific evaluation. The current literature on sudden infant death syndrome is reviewed in this section by Steven Blatt and Victoria Meguid. Specific studies about sleep position are analyzed and the rationale for the "back to sleep" movement is explained from a physiologic standpoint. The impact of maternal smoking and poor prenatal care is also reviewed in the form of a number of epidemiologic studies. It is important for the clinician to recognize that there is often a fine line differentiating sudden infant death syndrome and infanticide. The pediatrician needs to be aware of the importance of careful investigation of death scenes to insure that we are not missing other causes of death in those patients who are labeled as having died of sudden infant death syndrome.
Blood Coagulation↗
Postmortem orbital findings in shaken baby syndrome.
PURPOSE: To compare postmortem orbital findings in pediatric accidental head injury to Shaken Baby Syndrome (SBS). DESIGN: Retrospective study. METHODS SETTING: Institutional. STUDY POPULATION: Thirty-six patients underwent postmortem modified exenteration with sectioning of the orbital contents; 18 victims of SBS and 18 cases of fatal accidental head trauma. OBSERVATION PROCEDURE: In all cases of children who died from accidental head trauma, the orbital tissues were separated to expose the optic nerve sheath. Patients with gross evidence of hemorrhage within the sheath were included. All cases of SBS were included. After accidental head injury, exenteration was performed only if optic nerve sheath hemorrhage was suspected on gross examination. All children younger than 18 years old with head injury as primary cause of death were included. SBS is defined as having at least two of the following: (1) typical abnormal findings on neuroimaging, (2) typical skeletal injury, (3) retinal hemorrhages, (4) history of abusive shaking with or without blunt head trauma, or (5) an inadequate history to explain the observed injuries. MAIN OUTCOME MEASURE: Presence or absence of orbital hemorrhage. RESULTS: Orbital tissue injury is more common in SBS than accidental head trauma without orbital fracture. In addition, optic nerve sheath and optic nerve intradural hemorrhage are also significantly more common in SBS (P < .0001). CONCLUSIONS: Our study reports new evidence of injury to orbital tissues in SBS and supports the concept that these finding are due to unique acceleration-deceleration forces of this type of abusive head injury.
Child, Preschool↗
Intravitreal tissue plasminogen activator and pneumatic displacement of submacular hemorrhage secondary to retinal artery macroaneurysm.
PURPOSE: To assess the efficacy of treating submacular hemorrhages secondary to retinal arterial macroaneurysm with intravitreous tissue plasminogen activator (tPA) and gas. PATIENTS AND METHODS: Six consecutive patients (6 eyes) with submacular hemorrhage secondary to retinal arterial macroaneurysm were included in this study. Tissue plasminogen activator, at a dose of 50 microg/0.1 mL, was injected through the pars plana into the vitreous cavity. Gas (0.3-0.5 mL of perfluoropropane) instillation followed tPA injection, either immediately after injection or sometime during the next day. RESULTS: Best postoperative visual acuity improved in 5 of 6 eyes (83%) and was unchanged in 1 of 6 (17%) eyes. In 5 of 6 (83%) eyes, the procedure resulted in complete or partial displacement of submacular hemorrhage out of the foveal area. CONCLUSIONS: Intravitreous injection of tPA and gas, followed by prone positioning of the patient, is an effective and simple treatment of submacular hemorrhage secondary to retinal arterial macroaneurysm. No complication occurred in this series.
Aged↗
Unilateral Purtscher-like retinopathy after weight-lifting.
PURPOSE: To report a case of Purtscher-like retinopathy after weightlifting. METHODS: A 17-year-old man presented with a sudden visual loss in his left eye after weightlifting two weeks ago. Fundus examination of the left eye showed cotton-wool spots and scattered retinal hemorrhages in the posterior pole. Fluorescein angiography and indocyanine green angiography with a scanning laser ophthalmoscope were performed. RESULTS: Angiography showed hypofluorescent areas adjacent to the optic disc and in the posterior pole and partial filling insufficiency in the inferior and inferotemporal branch retinal veins. Complete venous filling was noted in late phases of angiography. CONCLUSIONS: The pathogenesis of weightlifting suggests the Purtscher-like changes as a result of Valsalva maneuver in our case. To our knowledge, this is the first reported case of Purtscher-like retinopathy associated with weightlifting.
Adolescent↗
Autoimmune encephalomyelitis and ocular lesions in monkeys sensitized during the neonatal period.
The neonatal rhesus monkey is susceptible to the induction of autoimmune encephalomyelitis. The disease has been produced regularly by injection of neonatal animals with guinea pig spinal cord antigen in complete Freund's adjuvant. The onset of the disease, as compared with onset in adults, is delayed and is most often heralded by intrinsic eye lesions, notably widespread retinal hemorrhages.
Animals↗
Development of the eye after gestational exposure to cocaine. Vascular disruption in the retina of rats and humans.
Clinical and basic research in the area of drugs of abuse are of utmost importance since they provide the necessary background for health programs in one of the main problems of contemporary society. The available data in this field demonstrate that acute, subacute and/or chronic abuse of illicit drugs, e.g., cocaine, alters the neurochemistry and functioning of the neural circuitries. Although recent works demonstrated that the visual system is lesioned after exposure to cocaine during the active periods of development, no studies have provided detailed information on the effects of these substances on the development of this sensory system. The present paper will report: 1) the vulnerability of the developing visual system to gestational exposure to cocaine; 2) the effects of cocaine in the visual system during the more active periods of development in humans and, as far as possible, the establishment of homologies with animal models where exposure is made in corresponding periods of human gestation, and 3) the characterization of the vascular disruption caused by ischemic/hypoxic mechanisms. The clinical study focused the ophthalmologic evaluation of newborns exposed in utero to illicit drugs. Newborns exposed to cocaine in utero showed marked vascular disruption in the retina: superficial and deep hemorrhages that, although morphologically similar to neonatal retinal hemorrhages, presented a longer reabsorption time when compared with the neonatal hemorrhagic lesions due to birth trauma in the general population. Prolonged eyelid edema was also a prominent finding. The animal study was conducted in Wistar rats exposed prenatally (gestational days 8 to 22) and postnatally (postnatal days 1-6, 1-13 and 1-29) to 60 mg/kg body weight/day and 15 mg/kg body weight/day, respectively, to cocaine hydrochloride administered subcutaneously; control groups included pair-feeding during the same experimental periods. Similar alterations to those observed in the newborns where exposure to cocaine was affirmative, were found: intraretinal hemorrhages allied to signs of chronic ischemia both in the outer retina-photoreceptor rosettes and in the inner retina-epiretinal glial membranes. Taking into consideration that the visual system is one of the more important sensory systems, the identification and characterization of these alterations, the similarity between animal and human findings, and their relation with cocaine per se, can provide a sound data base for illicit drug prevention programs.
Animals↗
High-altitude retinopathy.
Thirty-nine healthy subjects were examined before and after a stay at 5,360 m by ophthalmoscopy and by retinal photography. Twenty of them were also tested for visual acuity, scotomata, and capillary leakage. Vascular engorgement and tortuosity and disc hyperemia were seen in all subjects at altitude and are a "normal" response to hypoxia. Twenty-two (56%) of the subjects had retinal hemorrhages and one showed "cotton-wool spots". These changes are abnormal reactions and are considered high-altitude retinopathy. After maximal exertion on a cycle ergometer, fresh hemorrhages were observed in seven of 34 subjects. The incidence of hemorrhage associated with exercise was significantly greater than predicted. Fluorescein leakage was noted after exercise in eight of 20 persons tested and was associated with exercise-induced hemorrhages. Two persons developed premacular hemorrhages.
Adult↗
Cranial imaging in child abuse.
Serious head injury in children less than 2 years old is often the result of child abuse. The role of the different neuroimaging modalities in child abuse is reviewed. Skull X-ray and cranial CT are mandatory. Repeat or serial imaging may be necessary and brain MR imaging may contribute to the diagnostic work-up, particularly in the absence of characteristic CT findings. The radiologist plays an important role in accurately identifying non-accidental cranial trauma. The clinical presentation can be non-specific or misleading. The possibility should be considered of a combined mechanism, i.e., an underlying condition with superimposed trauma. In this context, the radiologist is in the front line to suggest the possibility of child abuse. It is therefore important to know the spectrum of, sometimes subtle, imaging findings one may encounter. Ophthalmological examination is of the greatest importance and is discussed here, because the combination of retinal hemorrhages and subdural hematoma is very suggestive of non-accidental cranial trauma.
Brain Injuries↗
Endogenous Aspergillus endophthalmitis occurring after kidney transplant.
Two months after renal transplantation, a 26-year-old man developed pneumonia that was recalcitrant to antibiotic therapy and proved by biopsy to be due to cytomegalovirus and Aspergillus fumigatus. Ten days later while on amphotericin B therapy, he developed an endophthalmitis proved by smear and culture of a vitreous aspiration to be caused by A. fumigatus. Despite intravitreous and systemic amphotericin B the vision deteriorated and the eye was enucleated. Microscopic examination disclosed an intense endophthalmitis with vitreous and retinal abscesses. The second patient was a 29-year-old woman who developed severe hypertension and graft rejection one month after renal transplant, despite massive immunosuppressive therapy with prednisone, azathioprine, and cobalt 60 irradiation. She developed pneumonia, meningitis, and died. A postmortem examination revealed disseminated aspergillosis. A single choroidal abscess due to Aspergillus with an associated retinal hemorrhage was observed in the left eye.
Adult↗
Prognostic significance and course of retinopathy in children with severe malaria.
OBJECTIVES: To relate retinal findings in children treated for severe malaria to disease outcome and to determine the course of changes in the fundus. METHODS: A prospective study of children with cerebral malaria (CM) and severe malarial anemia admitted to the Malaria Research Project, Blantyre, Malawi, during 2 malaria seasons. Indirect and direct ophthalmoscopy were performed on admission and daily, subject to the patient's cooperation. RESULTS: Three hundred twenty-six patients (91%) with complicated malaria were recruited. Two hundred seventy-eight patients had CM and of these 170 (61%) had some degree of retinopathy; 25 (53%) of 47 with severe malarial anemia had retinopathy. In CM, retinopathy was associated with subsequent death (relative risk, 3.7; 95% confidence interval, 1.6-8.5) and papilledema conferred the highest risk (relative risk, 4.5; 95% confidence interval, 2.7-7.6). Increasing severity of retinal signs was related to increasing risk of a fatal outcome (P<.05), independent of papilledema. In survivors, retinal signs were associated with prolonged time to recover consciousness (P<.001). Patients with severe malarial anemia had better outcomes and less severe retinopathy than those with CM. In 116 patients with CM, fundi were followed up longitudinally during admission and in 27 patients after hospital discharge. A large increase in retinal hemorrhages was associated with death (P =.02). Retinal signs resolved over 1 to 4 weeks without retinal sequelae. CONCLUSIONS: In childhood CM, severity of retinopathy is related to prolonged coma and death. Our results support the hypothesis that retinal signs in CM are related to cerebral pathophysiology.
Adolescent↗
Papillophlebitis: benign retinopathy resembling papilledema or papillitis.
Three young adult patients are described to illustrate an uncommon syndrome, papillophlebitis. This entity, characterized by mild but protracted monocular visual impairment, edema of the optic disc, retinal venous engorgement, and perivenous retinal hemorrhages, resembles atherosclerotic occlusion of the central retinal vein in older patients. In younger individuals it is benign and self limited, but may be incorrectly diagnosed as optic neuritis or papilledema. These alternatives can usually be excluded if tests of visual function do not indicate an optic nerve conduction defect and if the clinical presentation and examination of the opposite ocular fundus do not disclose evidence of increased intracranial pressure. Because resolution usually occurs spontaneously, immediate neuroroentgenographic tests may be inappropriate. Effective treatment has not been established; local instillation of corticosteroids may hasten recovery.
Adult↗
The effects of exposure to a 1.5-tesla magnetic field on intravitreous metallic foreign bodies in rabbits.
BACKGROUND: The study was performed to determine (1) whether intravitreous ferromagnetic foreign bodies (FBs) are sufficiently mobile in a magnetic field to induce acute injury in vivo, and (2) whether the length of time from implantation of the intravitreous FB affects mobility. METHODS: A 3 mm x 0.72 mm magnetic FB (MFB) and a non-magnetic metallic FB (NMFB) of similar dimensions were surgically implanted into the right and left eyes, respectively, of 20 New Zealand white rabbits. On days 0 (FB implantation) and 30, all rabbits underwent computed tomography (CT) prior to and immediately following exposure to a 1.5-tesla (T) magnetic field. Pre- and post-magnetic field CT image FB angles and distances, together with ophthalmic examinations, were used to assess FB mobility. Rabbits were killed at 31 days. The globes were processed for light microscopy (LM) and scanning electron microscopy (SEM). RESULTS: Angle measurements revealed that the MFBs developed significant angular motion and were scattered more widely than NMFBs on the day of FB implantation and 30 days later, although the angular motion and scatter of MFBs were less on day 30. There were no significant differences among distance measurements for MFBs or NMFBs on or between days 0 and 30. Throughout the 30-day study, ophthalmic examinations revealed dorso-ventral FB movement and focal vitreous degeneration and retinal hemorrhage within both MFB- and NMFB-containing globes. Mild vitreous hemorrhage was noted around a NMFB. Focal retinal degeneration was confirmed by LM ( n=1 MFB). SEM revealed intravitreous erythrocytes and spindle cells adjacent to all FBs examined. CONCLUSIONS: (1) Angle measurements show that MFBs are significantly mobile when exposed to a 1.5-T magnetic field on the same day as FB implantation and 30 days later. (2) Angular mobility of MFBs is less at 30 days. (3) Magnetic field exposure did not induce ocular injury in MFB-containing globes. (4) Intravitreous metallic FB retention induces ocular pathologic changes.
Animals↗