This is the first entry in the Grand Rounds section of Webvision. Todays images come from a 9 year old female who presented with retinal findings that include central ischemia with pre retinal hemorrhages due to Adderall, a drug used to treat attention deficit hyperactivity disorder (ADHD). The fluorescein angiogram images at the bottom show the extent of the central ischemic capillaries and the regions of non-perfusion in those areas of retina.
Photographs were made by James Gilman of the Moran Eye Center with a Zeiss FF-450+ using a Escalon Imaging 6MP camera.
I like the Grand Rounds approach.
“Adderall” is misspelled.
Thanks Ryan. Noted and changed.
Do we know if this child was abused at all? I am having an issue figuring out any kind of sound etiology for this type of hemorrhaging barring severe hypertension… It sounds more probable that these are from the child getting abused. Esp. a child already medicated for ADHD. I think it is a little brazen to claim that this is being caused by Adderall… The language used here is ardently unscientific.
Ryan,
There is no evidence that this child was abused. To my knowledge “shaken baby syndrome” would present with more shear findings in the retina and this retina demonstrates none of those findings despite the areas of “bleeding”. In addition, you only have to examine the pigmentary changes seen at the back of the eye and also acknowledge the areas in the retina devoid of circulation. These areas are not “bleeds”, but areas where there is no perfusion.