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Subhyaloid hemorrhage appears as extravasated blood beneath the retinal layer. These are often described as “boat-shaped” hemorrhages to distinguish them from the “flame-shaped” hemorrhages on the superficial nerve fiber layer of the retina. They may occur as a result of blunt trauma but are perhaps best known as a marker for SAH. In SAH, the hemorrhages appear as a “puff” of blood emanating from the central disk.
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SAH, shaken impact syndrome, hypertensive retinopathy, and retinal hemorrhage should all be considered and aggressively evaluated.
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Management and Disposition
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No specific treatment is required for subhyaloid hemorrhage. Treatment is dependent on the underlying etiology. Appropriate specialty referral should be made in all cases.
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A funduscopic examination looking for subhyaloid hemorrhage should be included in all patients with severe headache, unresponsive pediatric patients, or those with altered mental status.
The appearance of a retinal hemorrhage indicates its anatomic location. A subhyaloid hemorrhage lies over the retinal vessels—thus, they cannot be seen on funduscopic examination. In a subretinal hemorrhage (see Fig. 3.4), the vessels lie superficial to the hemorrhage and thus are easily seen.
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