Cases reported "Retinal Hemorrhage"

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1/84. White-centred retinal haemorrhages (Roth spots).

    Roth spots (white-centred retinal haemorrhages) were classically described as septic emboli lodged in the retina of patients with subacute bacterial endocarditis. Indeed many have considered Roth spots pathognomonic for this condition. More recent histological evidence suggests, however, that they are not foci of bacterial abscess. Instead, they are nonspecific and may be found in many other diseases. A review of the histology and the pathogenesis of these white-centred haemorrhages will be provided, along with the work-up of the differential diagnosis.
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2/84. Recurrent malignant hypertension: a report of two cases and review of the literature.

    Malignant hypertension (MHT) is a rare and life-threatening condition which is defined clinically as severe hypertension accompanied by bilateral retinal haemorrhages and/or hard exudates, with or without papilloedema. If untreated, the prognosis of MHT is poor. With MHT being a relatively rare condition, it would be unusual to see it on more than one occasion in the same patient. We describe in detail two cases from a disease register of 400 cases of MHT seen in one medical centre over 33 years.
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3/84. Preretinal haemorrhages: an unusual manifestation of intravitreal amikacin toxicity.

    PURPOSE: To report a case with multiple preretinal haemorrhages after intravitreal amikacin. METHOD: A 58-year-old patient developed postoperative endophthalmitis following a routine extracapsular cataract extraction in his left eye. He received two intravitreal injections of cephazoline (2.25 mg) and amikacin (0.4 mg), given 48 h apart. RESULTS: The patient presented to us with large preretinal haemorrhages at the posterior pole. Multiple large areas of blocked fluorescence were seen on fundus fluorescein angiography. CONCLUSION: Widespread posterior pole preretinal haemorrhages may be an unusual manifestation of intravitreal amikacin toxicity.
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4/84. A 12-year ophthalmologic experience with the shaken baby syndrome at a regional children's hospital.

    PURPOSE: To examine the ophthalmologic experience with the shaken baby syndrome (SBS) at one medical center, including clinical findings, autopsy findings, and the visual outcome of survivors. methods: One hundred sixteen patients admitted from 1987 to 1998 for subdural hematomas of the brain secondary to abuse were included. RESULTS: Retinal hemorrhages were detected in 84% of the children, but this important finding had been missed often by nonophthalmologists. Poor visual response, poor pupillary response, and retinal hemorrhage correlated strongly with demise of the child. One child who died had pigmented retinal scars from previous abuse, a condition not previously observed histopathologically. The clinical and autopsy findings varied somewhat, probably because of the differing conditions for examination. No correlation could be made between computerized tomography scans done during life and the subdural hemorrhage of the optic nerve found on autopsy. Half of the surviving patients were known to have good vision. One fourth of the patients had poor vision, largely due to cerebral visual impairment from bilateral injury posterior to the optic chiasm. Severe neurologic impairment correlated highly with loss of vision. CONCLUSION: This series provides information on the frequency of eye findings in SBS patients. No fundus finding is pathognomonic for SBS. When retinal hemorrhages are found in young children, the likelihood that abuse occurred is very high. The difficulty that nonophthalmologists have in detecting retinal hemorrhage may be an important limiting factor in finding these children so they may be protected from further abuse.
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5/84. Ocular and cerebral involvement in familial lymphohistiocytosis.

    A 5-month-old infant girl died of familial lymphohistiocytosis. The central nervous system showed widespread perivascular infiltration of the cerebral pia and arachnoid, the cerebral white matter and deep gray matter, the cerebellum, and brain stem by lymphocytes, benign appearing histiocytes, and macrophages with erythro-and lymphophagocytosis. The eyes had mild infiltration of the anterior uveal tract, moderate involvement of the inner retina, and marked infiltration of the optic nerves by identical cells.
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6/84. Intravitreal tissue plasminogen activator in submacular haemorrhage.

    Submacular haemorrhage is a major cause of sudden visual loss in age-related macular degeneration (AMD). If left untreated it often results in permanent central visual loss. We present our experience in the use of intravitreal tissue plasminogen activator (tPA) in a 65-year-old male with submacular haemorrhage.
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7/84. Ocular decompression retinopathy after resolution of acute primary angle closure glaucoma.

    A patient presented with acute primary angle closure glaucoma with markedly elevated intraocular pressure. Two weeks after laser peripheral iridotomy and resolution of the acute attack, the patient was noted to have developed scattered retinal haemorrhages. The haemorrhages resolved over time with no visual sequelae. This is the first reported case of ocular decompression retinopathy after resolution of acute primary angle closure glaucoma.
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8/84. Cavernous haemangioma of the retina and optic disc. A report of three cases and a review of the literature.

    We report characteristics of three cases of cavernous haemangioma of the retina, bringing to 37 the number now reported in the available literature. This rare, benign, congenital malformation is non-progressive, usually unilateral, somewhat more frequent in women, and rarely a source of intraocular haemorrhage. The fluorescein angiographic features include a normal arterial and venous supply, extraordinarily slowed venous drainage, no arterio-venous shunting, no disturbances of vascular permeability, and no secondary retinal exudation. Almost always, isolated clusters of vascular globules with plasma/erythrocyte sedimentation surround the main body of the malformation. These findings differentiate the anomaly from other retinal vascular diseases. Therapeutic intervention is seldom necessary.
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9/84. factor vii deficiency in a patient with retinal arteriolar tortuosity syndrome.

    PURPOSE: To report a pedigree with hereditary retinal arteriolar tortuosity with macular haemorrhage and abnormality of the coagulation system. methods: Case report and literature review. RESULTS: A 49-year-old woman was referred due to macular haemorrhage in both eyes. Her 16-year-old son had recurrent retinal haemorrhages which presented at age 16 years and had mild retinal arteriolar tortuosity. Coagulation studies in the son revealed normal activated partial thromboplastin time (APTT), prolonged prothrombin time (PT) and 30% activity of factor VII. CONCLUSIONS: factor vii deficiency may aggravate the haemorrhages in retinal arteriolar tortuosity syndrome. We therefore suggest conducting routine coagulation studies (PT, APTT) in all patients with retinal arteriolar tortuosity syndrome. Determination of factor VII activity is warranted only in patients with normal APTT and prolonged PT.
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10/84. Retinal haemorrhage and fatal stroke in an infant with fibromuscular dysplasia.

    Non-accidental injury should be suspected and excluded in any infant found to have intracranial and retinal haemorrhage of unknown aetiology. This can be a sensitive issue for both medical staff and parents. We present a case in which the underlying cause of intracranial and retinal haemorrhage was fibromuscular dysplasia. It was a diagnosis made only at postmortem examination and it illustrates the diagnostic difficulty such cases may present.
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