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Retinal hemorrhage predicts neurologic injury in the shaken baby syndrome.

Shaken baby syndrome consists of intracranial and intraocular hemorrhage in the absence of signs of direct trauma in infants who have sustained whiplash/shaking injuries. We evaluated 14 consecutive cases of presumed shaken baby syndrome seen at the University of Michigan Hospitals, Ann Arbor, between August 1983 and March 1988, to determine if the severity of retinal hemorrhage was predictive of the severity of acute neurologic injury. The severity of retinal hemorrhage was based on the type and size of hemorrhage and the extent of fundus involvement. We found a significant correlation between retinal hemorrhage severity and acute neurologic findings. Diffuse fundus involvement, vitreous hemorrhage, or large subhyaloid hemorrhages were associated with more severe acute neurologic injury.

Brain Injuries↗

High altitude retinal hemorrhage.

The accessibility of high-altitude areas presents the risk of high altitude retinal hemorrhages (HARH). Four cases reported illustrate localized macular, diffuse, and familial incidence of HARH. Fluorescein angiography indicated no leakage, and a superficial retinal location of the hemorrhages. Marked retinal artery and vein dilation occurs. Ophthalmodynamometry showed retinal vascular hypertension in the presence of HARH. The complete resolution of hemorrhages occurs in most cases. Despite the return of visual acuity to normal, visual function studies indicate the persistance of defects.

Adult↗

Transillumination enhances photographs of retinal hemorrhages.

Light stand photography with direct illumination of the retina is a common method of demonstrating retinal hemorrhages. The lack of contrast between dark hemorrhages and surrounding dark retina, and the difficulty of photographing into the concavity of an eye limit this technique. Transillumination of a bivalved globe with a bright external light source such as a colonoscope or microscope light yields high contrast superior photographs. This technique is useful to document retinal hemorrhages, and provides quality photographs for courtroom demonstrations.

Autopsy↗

White-centered retinal hemorrhages as an early sign of preeclampsia.

PURPOSE/METHOD: We examined a pregnant patient who had symptomatic white-centered retinal hemorrhages. Severe preeclampsia rapidly developed despite the patient not having hypertension, proteinuria, or edema at initial examination. RESULTS/CONCLUSIONS: Retinal hemorrhages gradually resolved without treatment and visual acuity returned to 20/20 six months after emergency delivery of a healthy infant. Retinal or choroidal vascular abnormalities in pregnant patients may be caused by early preeclampsia and immediate obstetric referral is indicated.

Adult↗

Acute angle-closure glaucoma resulting from spontaneous hemorrhagic retinal detachment in age-related macular degeneration: case reports and literature review.

PURPOSE: Acute angle-closure glaucoma resulting from massive subretinal hemorrhage is a rare and catastrophic complication in age-related macular degeneration. Anticoagulant usage had been strongly correlated with this complication in previously reported cases. METHODS: Four patients (4 eyes), 3 men and 1 woman, developed angle-closure glaucoma with diffuse subretinal hemorrhage and total hemorrhagic retinal detachment. RESULTS: Serial funduscopic examinations and echographic studies in 2 eyes showed that the blood gradually accumulated in the subretinal space. It took more than 10 days for the bleeding to build up to bullous hemorrhagic retinal detachment and secondary glaucoma. Anti-glaucomatous agents were given and sclerotomy was performed in 3 of the 4 patients. Phthisical changes were observed subsequently in these 3 eyes. The eye that received early drainage of blood was an exception, and a small degree of residual acuity was retained. Three of the 4 patients had diabetes mellitus, and hypertension and vascular diseases were also present in the same 3 patients. CONCLUSIONS: Diabetes mellitus might be a predisposing factor for the impaired hemostasis. Anti-glaucomatous agents were of no effect in the management of intraocular pressure. Sclerotomy and drainage of blood help control intraocular pressure and relieve ocular pain. Poor final visual acuity is inevitable. However, phthisical changes might be prevented with early sclerotomy and drainage of blood.

Acute Disease↗

Preretinal and retinal hemorrhage due to chronic subdural hematoma.

A case report of a 58-year-old man with preretinal and retinal hemorrhages due to chronic subdural hematoma is presented. Three weeks after head injury in a motor vehicle accident, a few peripapillary retinal hemorrhages with slightly blurred margins of the optic disk were seen in both eyes; subretinal and preretinal hemorrhages developed subsequently. Computed tomography revealed right frontal subdural hematoma, though there were no neurologic findings. Preretinal hemorrhages associated with subdural hematoma are uncommon in adults, and no photographic evidence of such hemorrhages has been published. The patient was treated nonsurgically, and the ocular hemorrhages resolved gradually.

Hematoma, Subdural↗

Improved documentation of retinal hemorrhages using a wide-field digital ophthalmic camera in patients who experienced abusive head trauma.

OBJECTIVE: To describe the clinical use of a wide-field digital ophthalmic camera (RetCam 120; Massie Research Laboratories, Inc, Dublin, Calif) for the documentation of retinal hemorrhages in patients who experienced abusive head trauma. DESIGN: Case series. SETTING: Pediatric intensive care unit at a tertiary care center. PARTICIPANTS: Children with suspected abusive head trauma. RESULTS: Eight children were studied during a 9-month period. The median age of the children was 2.25 months (range, 0.8-18.0 months). There were 4 male and 4 female patients. All patients had intracranial bleeding, documented by computed axial tomographic scans of the head. Of the 8 patients, 6 had bilateral retinal hemorrhages. All patients underwent a formal examination by a pediatric ophthalmologist (R.S. and others) using a wide-field digital ophthalmic camera. Three children died. CONCLUSIONS: The wide-field digital ophthalmic camera allowed good visualization and produced high-quality photographic images, resulting in instant bedside documentation of retinal pathological features. The wide-field digital ophthalmic camera provides a new tool for the evaluation and precise documentation of retinal hemorrhages in suspected and confirmed cases of abusive head trauma.

Child Abuse↗

Sub-retinal hemorrhage during internal limiting membrane peeling for a macular hole.

PURPOSE: To report the occurrence of sub-retinal hemorrhage during peeling of the internal limiting membrane (ILM). CASE REPORTS: In case 1, a three-port pars plana vitrectomy was performed on a 57-year-old woman with a macular hole. Following the staining of the ILM with indocyanine green, the ILM was peeled with forceps, and a sub-retinal and vitreous hemorrhage resulted from a vein during the peeling. The bleeding was stopped by elevating the intraocular pressure. The final visual acuity was 20/30. In case 2, similar procedures were performed on a 68-year-old woman with a macular hole. A sub-retinal hemorrhage occurred while peeling the ILM. The pre-operative visual acuity was 20/300, and final visual acuity was 20/200. CONCLUSIONS: Surgeons should be aware that sub-retinal and vitreous hemorrhage can be a complication of ILM peeling.

Aged↗

Retinal hemorrhages. Its significance in 100 patients with acute encephalopathy of unknown cause.

A total of 94 patients had subarachnoid hemorrhage and it was strongly suspected in the remaining six patients. Acute encephalopathy associated with independent ocular hemorrhage due to hypoxia, multiple emboli, or bleeding tendencies was not a diagnostic problem during this study. Aneurysms occurred in 64 patients (combined with vascular malformations in four), isolated vascular malformations in four; "spontaneous" hematomas in 13, evidence of cryptic head trauma in six, hemorrhage from a glioblastoma in one, and no cause was identified in six patients. Retinal hemorrhages were more prominent ipsilateral to the site of intracranial bleeding. No single aneurysm location predominated and multiple aneurysms were common. The high mortality of 56% supports previous conclusions that retinal hemorrhages tend to accompany severe intracranial bleeding.

Arteriovenous Malformations↗

Bilateral retinal hemorrhages and disk edema in migraine.

A 27-year-old patient with severe migraine developed bilateral disk edema and retinal hemorrhages during a prolonged attack of his illness, lasting at least two months. The combination of bilateral disk edema and diffuse superficial retinal hemorrhages was considered to be a manifestation of prolonged valsalva efforts accompanying the migraine attack and of not persistent raised intracranial pressure.

Adult↗

Inherited retinal arteriolar tortuosity with retinal hemorrhages.

BACKGROUND: Familial arteriolar tortuosity is an autosomal dominant disorder affecting the retinal arterioles. OBJECTIVES: To report a pedigree with this disorder and describe a systemic workup to determine whether this vascular abnormality is limited to the eye. RESULTS: A 58-year-old woman referred for retinal hemorrhages was found to have retinal arteriolar tortuosity of both eyes, especially in the macular area. Her 63-year-old brother had a history of retinal hemmorhages beginning at age 18 years and had similar fundoscopic examination findings. The proband had an extensive systemic workup, including magnetic resonance imaging, and cardiac and renal angiography, that failed to demonstrate any other sequelae of this inherited ocular syndrome. However, each member of the family expressing this phenotype did have hypertension. CONCLUSION: Inherited retinal arteriolar tortuosity is an autosomal dominant disorder limited to the eye, at least in this pedigree, within the sensitivity of the systemic workup we used.

Adult↗

Branch retinal vein occlusion in the right eye and retinal hemorrhage in the left in a patient with classical Tsutsugamushi disease.

PURPOSE: To report branch retinal vein occlusion and retinal hemorrhages associated with tsutsugamushi disease. METHODS: Case report of a 60-year-old woman who complained of fever, chills, headache, lymphadenopathy, and blurred vision in the right eye following an insect bite to the lower right forehead. RESULTS: Serological findings showed elevated titers for the strains of Rickettsia tsutsugamushi. Ophthalmologic examination disclosed bilateral conjunctival injection, flame-shaped hemorrhage in her right fundus, and scattered hemorrhage in her left fundus. Fluorescein angiography demonstrated dye leakage and dilation of capillaries. CONCLUSIONS: Branch retinal vein occlusion associated with classical tsutsugamushi disease, as demonstrated in our patient, may be rare.

Antibodies, Bacterial↗

[Malaria and retinal hemorrhages].

A 24-year-old woman presented with retinal hemorrhages, back from a travel in Cameroon. She took a chloroquine chemoprophylaxis. We diagnosed a malaria due to Plasmodium falciparum with anemia, splenomegaly and low parasitemia. A speedy clinical and ophthalmological recovery was obtained with mefloquine therapy. We discuss physiopathology of such uncommon retinal damage during malaria.

Adult↗

Isolated retinal hemorrhages associated with oral contraceptives.

Seven patients had isolated retinal hemorrhages without other systemic or ocular disease in a six-year period. Six patients were females, of whom five were taking oral contraceptives. The number of patients taking contraceptives and the fact that one patient had a similar episode earlier during pregnancy suggested a hormonal etiology. In the two patients we examined, we concluded that direct hormonal action causing vascular wall lesions was probably responsible for the pathology.

Adolescent↗