| Identifier |
roth_spot_lee_novel |
| Title |
Roth Spot |
| Creator |
Andrew G. Lee, MD; Anirudh Mukhopadhyay |
| Affiliation |
(AGL) Chairman, Department of Ophthalmology, The Methodist Hospital, Houston, Texas; Professor of Ophthalmology, Weill Cornell Medicine, New York City, New York; (AM) Class of 2023, Baylor College of Medicine, Houston, Texas |
| Subject |
Roth Spot; Litten Sun; Lesion; Hemorrhage; Retino-Vascular Disorders |
| Description |
Summary: • Roth spot (Litten sun) is a red lesion with a white center due to a platelet-thrombin complex in the middle of a hemorrhage. o Result of some sort of endothelial damage in the blood vessel and that leads to the leakage of the blood. o The platelet-fibrin complex builds up inside the hemorrhage to close the endothelial damage and the leakage of the blood. • Differential diagnosis of Roth Spots are uncommon presentations of common disorders or uncommon disorders: o Uncommon presentations of common disorders > Retino-vascular disorders (ie. diabetes and diabetic retinopathy) > Hypertension > Hematologic anomalies (anemia, thrombocytopenia, and hypercoagulable states) > Subacute bacterial endocarditis • Characteristic features: splinter hemorrhages, Janeway lesions, and Osler's nodes • Systemic features: Fever and elevated WBC > Other infectious cause (HIV, syphilis, etc.) o Uncommon disorders > Purtscher's retinopathy > Response to endothelial damage • Intrathoracic pressure • Cardiopulmonary resuscitation • Pancreatitis • Pertinent laboratory finding include but are not limited to blood pressure, hemoglobin A1C, hematologic values (CBC, PT, PTT, platelet count, etc.), blood smear, and bacterial cultures. o May sure to check for subacute bacterial endocarditis! • Even though the uncommon presentation of the common disorder is more likely, it is equally important to rule out the uncommon disorders. |
| Transcript |
Today we're going to be talking about the Roth Spot in neuro-ophthalmology, sometimes also referred to as a Litten sun and it's a very characteristic appearing lesion. It's red because it's a hemorrhage, but in the middle is a white spot. So it's a white centered hemorrhage. And even though there's a long list of things that can produce this ophthalmoscopic feature of the white centered hemorrhage or Roth spot, really, we shouldn't be thinking about it in terms of a final common pathway for a pathogenic mechanism which is this white center is platelet-fibrin complex. So, this platelet-fibrin complex is inside of a hemorrhage. So presumably the thing that is unifying all the mechanisms for the Rothspot are there's some sort of endothelial damage here in the blood vessel and that leads to the leakage of the blood but because the primary pathophysiology is something in the blood (systemic) that the platelet-fibrin complex is building up inside the hemorrhage to close the endothelial damage and the leakage side of the blood. So, the Roth Spot could either be an uncommon presentation of common disorders that affect endothelium - and of course the most common retino-vascular disorders that we face in neuro-ophthalmology are diabetes and diabetic retinopathy and hypertension as well as problems with the blood (hematologic abnormalities most prominently anemia and thrombocytopenia but also all of the hypercoagulable states) or it could be infectious. And of course, we're going to round up the usual suspects and the usual suspect for the Roth Spot is the subacute bacterial endocarditis and so we're going to be looking for splinter hemorrhages, the Janeway lesions, and Osler nodes (the characteristic features) as well as fever or elevated white count (the systemic manifestations) of subacute bacterial endocarditis (SBE). The other infectious things that we have to worry about of course are HIV retinopathy which also can produce the isolated cotton wool spot. And, you know the usual suspects: syphilis etc. So, patients who have these major categories are uncommon presentations of common disorders or you could have the uncommon disorders and the uncommon disorders are things like Purtscher's retinopathy which usually produces the cotton wool spots and that also is a final common pathway for things like intrathoracic pressure, cardiopulmonary resuscitation, pancreatitis that involve emboli -either septic embolior platelet-thrombin complexes responding to endothelial damage. And so, when we see the cotton wool spot, we're really going to be thinking about the same things that we're thinking about with the Roth Spot. So, both the cotton wool spot and the Roth Spot are sentinels of underlying systemic disease. And so, you've got to check their blood pressure, hemoglobin A1C, and the usual things, the hematologic things (CBC, PT, PTT, platelet, blood smear) the infectious etiologies, but especially be thinking about subacute bacterial endocarditis, HIV, syphilis, and even though the uncommon presentation of the common disorder is more likely you really need to be focused on ruling out the uncommon disorders when confronted with a white centered hemorrhage, the Roth Spot. |
| Date |
2021-04 |
| Language |
eng |
| Format |
video/mp4 |
| Type |
Image/MovingImage |
| Collection |
Neuro-Ophthalmology Virtual Education Library: Andrew G. Lee Collection: https://novel.utah.edu/Lee/ |
| Publisher |
North American Neuro-Ophthalmology Society |
| Holding Institution |
Spencer S. Eccles Health Sciences Library, University of Utah |
| Rights Management |
Copyright 2019. For further information regarding the rights to this collection, please visit: https://NOVEL.utah.edu/about/copyright |
| ARK |
ark:/87278/s6dc3zg1 |
| Setname |
ehsl_novel_lee |
| ID |
1680624 |
| Reference URL |
https://collections.lib.utah.edu/ark:/87278/s6dc3zg1 |
