Diffuse bilateral retinal hemorrhages in an infant with a coagulopathy and prolonged cardiopulmonary resuscitation

Levinson, Joshua D.; Pasquale, Melissa A.; Lambert, Scott R.

doi:10.1016/j.jaapos.2015.11.003

Cited by 6 publications

(6 citation statements)

References 9 publications

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“…Because of some few cases being reported, 14 no specific and codified management of ocular complications during meningococcemia was found in our literature search. Therefore, we believe that an ophthalmic examination should be performed for unconscious patients with DIC during meningococcemia to discuss early imaging and intervention.…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Vitreoretinal Complications During Disseminated Intravascular Coagulation Secondary to Meningococcemia

Keilani

Delbarre

Rambaud

et al. 2022

RETINAL Cases &Amp; Brief Reports

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Purpose: To report a case of the surgical management of vitreoretinal complications during disseminated intravascular coagulation secondary to meningococcemia.Methods: A case report.Results: A 25-year-old man presented with loss of vision due to retinal and vitreous hemorrhages during disseminated intravascular coagulation secondary to meningococcemia. Examination revealed the visual acuity to be counting fingers in the right eye and light perception in the left eye. Bilateral vitreous hemorrhages were found on fundus examination. A dome-shaped lesion overlying the macula consistent with a subinternal limiting membrane hemorrhage was seen on optical coherence tomography. Bilateral vitrectomy was performed. Multiple subinternal limiting membrane hemorrhages were evident in the posterior pole. A membrane forceps was used to peel the internal limiting membrane and remove the fibrin under it. The internal limiting membrane and vitreous samples were sent for anatomopathological examination confirming our hypothesis. The peripheral retina revealed bilateral multiple ischemic areas, and argon laser photocoagulation was performed on it. Both eyes were filled with silicone oil. Eight months after surgery, his vision improved to 70 and 65 on the early diabetic retinopathy study scale in the right and left eyes, respectively.Conclusion: Published cases of retinal and vitreous hemorrhages during disseminated intravascular coagulation secondary to meningococcemia are few. There is no specific and codified management of these ocular complications. This case is the first reporting positive visual recovery after surgical treatment. Surgical procedure seems to be effective to treat multiple vitreoretinal hemorrhages secondary to meningococcemia.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Vitreoretinal Complications During Disseminated Intravascular Coagulation Secondary to Meningococcemia

Keilani

Delbarre

Rambaud

et al. 2022

RETINAL Cases &Amp; Brief Reports

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“…RHs in these diagnoses are almost always few in number and are confined to the posterior retina, although exceptions exist. 16,33 Hyperacute elevations of intracranial pressure, as seen in crush injuries or ruptured aneurysms, can also occasionally result in severe RHs. 34 Occipital impact or epidural hemorrhage may lead to RH and is usually intraretinal and confined to the posterior pole.…”

Section: Rhs In Other Diseasesmentioning

confidence: 99%

The Eye Examination in the Evaluation of Child Abuse

Christian

Levin

Flaherty³

et al. 2018

Pediatrics

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Child abuse can cause injury to any part of the eye. The most common manifestations are retinal hemorrhages (RHs) in infants and young children with abusive head trauma (AHT). Although RHs are an important indicator of possible AHT, they are also found in other conditions. Distinguishing the number, type, location, and pattern of RHs is important in evaluating a differential diagnosis. Eye trauma can be seen in cases of physical abuse or AHT and may prompt referral for ophthalmologic assessment. Physicians have a responsibility to consider abuse in the differential diagnosis of pediatric eye trauma. Identification and documentation of inflicted ocular trauma requires a thorough examination by an ophthalmologist, including indirect ophthalmoscopy, most optimally through a dilated pupil, especially for the evaluation of possible RHs. An eye examination is helpful in detecting abnormalities that can help identify a medical or traumatic etiology for previously well young children who experience unexpected and unexplained mental status changes with no obvious cause, children with head trauma that results in significant intracranial hemorrhage and brain injury, and children with unexplained death.

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“…In fact, the literature would argue strongly against the possibility of coagulopathy resulting in extensive retinal hemorrhages in a child. 9 I agree with their statement that "the consensus in the literature is that CPR is not a significant risk factor for severe" retinal hemorrhage, yet they cite a single case report 10 that had far fewer hemorrhages than the case of Levinson and colleauges, 4 no coagulopathy, and multiple other risk factors pre-and postmortem, which may have contributed to retinal hemorrhages that weren't seen in the case of Levinson and colleagues. 4 In addition, the pre-CPR examination, which found no retinal hemorrhages in the cited case, was conducted by a nonophthalmologist.…”

mentioning

confidence: 93%

“…In this issue, Levinson and colleagues 4 present an 8-week-old child who slept "more than any infant [the family] had ever known." The child was in the care of multiple family members when the child was found unconscious.…”

mentioning

confidence: 99%