Roth spot: signs, symptoms, and causes

Description

Retinal hemorrhage round, white center

Image. Roth spot

Cause

Initially, Roth spot was thought to be characteristic of subacute infective endocarditis, but it can also be seen in many other conditions such as:

Popular

Infective endocarditis.

Decreased tissue oxygen.

Less popular

Proliferative myeloid syndrome.

Intracranial hemorrhage.

Diabetes.

Child tremor syndrome.

Mechanism

Roth spot is not caused by bacterial thrombosis. The currently accepted hypothesis is that the capillaries are ruptured and fibrin aggregates.

By this mechanism, lesions rupture retinal capillaries, ejecting blood, activating platelets, coagulation cascade, and platelet fibrin plug. Fibrin is the white part of the hemorrhage.

The primary lesion depends on the pathology of the stroma:

It is thought that, in subacute infective endocarditis, thrombocytopenia secondary to mild disseminated intravascular coagulation may promote bleeding from retinal capillaries.

Anemia may aggravate hypoxic tissue damage to retinal capillaries in patients with subacute infective endocarditis and leukemia.

Increased venous pressure leads to ischemia of capillary endothelial cells and, consequently, capillary rupture.

Flowchart of Roth spotting mechanism

Significance

There are many possible causes of Roth spot as mentioned and it can only be found in <5% of patients with infective endocarditis, so its value is independent of its other clinical features. is limited.

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