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BACKGROUND: To report four cases with interesting anatomical presentations of multilayer macular hemorrhages with preretinal hemorrhage possibly preventing subretinal involvement of the macular area. CASES PRESENTATION: Observational study of four patients presenting with macular hemorrhages. RESULTS: Four patients with multilayer macular hemorrhage due to different causes, presented with a halo-shaped submacular hemorrhage coincident with the preretinal hemorrhage borders. After resolution, in all cases, the macular area underneath the preretinal hemorrhage was found to be spared. CONCLUSION: We hypothesized that an extensive preretinal hemorrhage can exert a mechanical force pushing the subretinal hemorrhage towards the periphery, consequently protecting the macular area.

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PURPOSE: To report the fundus manifestations and spectral-domain optical coherence tomographic (SD-OCT) features of dengue fever presenting as Purtscher-like retinopathy. METHODS: Retrospective review of two cases of dengue fever. RESULTS: Color fundus photograph revealed the presence of cotton-wool spots in a Purtscher-like configuration in the posterior pole of all study eyes. SD-OCT demonstrated increased reflectivity signal in the inner retinal layers, and after a variable follow-up period, there was complete disappearance of cotton-wool spots and persistence of the hyperreflectivity signal. CONCLUSION: We report two unique cases of dengue fever associated with retinal lesions in a configuration of Purtscher-like retinopathy.

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Introducción: El Dengue es una infección viral aguda, causada por un virus de la familia Flaviviridaeque se transmite por la picadura del mosquito Aedes Aegypti. Se han descrito manifestaciones oculares asociadas a esta enfermedad como son: maculopatía, hemorragias retinales, neuritis óptica, retinitis y vasculitis, aunque son poco frecuentes. Objetivo: Presentar un caso con manifestaciones oculares después de ser diagnosticado con Dengue. Presentación del caso: Paciente masculino de 58 años de edad que 1 mes después de haber padecido Dengue comienza a presentar visión borrosa en ambos ojos, constatándose al examen oftalmológico del fondo de ojo, hemorragias maculares y exudados escasos en algunos cuadrantes en ambos ojos. Recibió tratamiento con antiinflamatorios sistémicos por 2 meses y mejoró su sintomatología inicial, así como el cuadro clínico fondoscópico. Conclusiones: El Dengue es una enfermedad con repercusión no solo sistémica sino también oftalmológica lo que, aunque no es muy frecuente, debe tenerse presente. Resultaron de considerable utilidad la clínica, la retinofoto y la tomografía de coherencia óptica (OCT) para el seguimiento de las alteraciones retinianas halladas posterior a su aparición. Los esteroides fueron utilizados con éxito para el tratamiento en este caso(AU)

Introduction: Dengue is an acute viral infection, caused by a virus of flaviviridae family that is transmitted by the Aedes Aegypti mosquito sting. Ocular manifestations associated to this illness have been described such as maculopathy, retinal hemorrhages, optic neuritis, retinitis and vasculitis, although they are not frequent. Objective: To present a case that is not frequently reported in own context. Case presentation: 58-year-old male patient that suffered from dengue and 1 month after that he began having blurred vision in both eyes. In the ophthalmic examination, it was detected that he had macular hemorrhages and exudates in some quadrants of both eyes. He was treated with systemic antiinflammatories for 2 months. There was an improvement of his initial symptoms and the clinical features of the ocular fundus with this treatment. Conclusions: Dengue is an illness that has not only a systemic impact but also causes ophthalmic damage that we should consider. The clinical manifestations, the retinophoto and the optical coherence tomography (OCT) were considerably useful for the follow-up of the retinal alterations found post-dengue. Steroids were used successfully for the treatment of this case(AU)

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El síndrome del niño sacudido es una de las formas más severas de maltrato infantil que ocurre principalmente en niños menores de un año. Por la vulnerabilidad de las víctimas y por las secuelas que puede producir, incluyendo la muerte, es necesario, en el abordaje clínico, tener presente la sospecha diagnóstica ante lesiones de explicación insatisfactoria por parte de los encargados del menor. Asimismo si se trata de un abordaje médico legal deben tenerse las consideraciones necesarias para documentar las lesiones, tanto en el paciente vivo, como en los casos de homicidio, para colaborar con la administración de justicia. Para ello se debe tratar de implementar una metodología homogénea para la realización de dichas pericias, tanto en la parte clínica como patológico forense. En este artículo se describe la forma habitual de presentación clínica del síndrome del niño sacudido y se expone una guía básica para la realización de autopsias medico legales en casos de muertes por esta causa.

The shaken baby syndrome is one of the most severe presentations of child abuse that is seen in children especially under the first year of age. The great vulnerability of this group of patients and the serious consequences that they may encounter in the future, including death, are enough reason to inquire, during the clinical approach, about the possibility that the patient being attended may be a victim of physical abuse. From a medico-legal evaluation, it is pertinent to document and describe thoroughly the physical lesions in the living patient and in cases of homicide, in order to contribute scientifically in the administration of justice. For that reason it is essential to follow a uniform methodology in the management of both the clinical and the forensic assessment. This article reviews the usual clinical presentation of the shaken baby syndrome and proposes a basic guide to evaluate the autopsies in cases of deaths originated by this cause.

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