Roths spot
Roths spots, also known as Litten spots or the Litten sign, are non-specific red spots with white or pale centres, seen on the retina and although traditionally associated with infective endocarditis, can occur in a number of other conditions including hypertension, diabetes, collagen vascular disease, extreme hypoxia, leukemia and HIV.Red and white retinal spots were first observed in 1872 by Swiss physician Moritz Roth, and named "Roth spots" six years later by Moritz Litten. They are typically observed via fundoscopy (using an ophthalmoscope to view inside the eye) or slit lamp exam.The original retinal spots identified in 1872 were attributed to nerve-fibres that had burst. Present-day analysis shows that they can be composed of coagulated fibrin including platelets, focal ischaemia, inflammatory infiltrate, infectious organisms, or neoplastic cells.

Cause
Roths spots occur in conditions that predispose to endothelial damage of retinal capillaries, that is when there is dysfunction and disruption of the endothelium of retinal capillaries. Looking through the microscope reveals lesions with white centers made mainly of fibrin, depicting a fibrin-platelet plug at the site of vessel damage.

Associated conditions
Conditions associated with Roths spots include:

Infective endocarditis
Anaemia/thrombocytopenia
Collagen vascular disease
Leukemia
Hypertensive retinopathy
Diabetic retinopathy
Pre-eclampsia
Human Immunodeficiency Virus (HIV)
Extreme hypoxia
Shaken-baby syndromeand also:
Candida albicans infection
vascular diseases
kala azar

Prevalence
Roths spots occur in only 5% of people with infective endocarditis. Litten, however reported a figure of 80%.

See also
Oslers nodes
Janeway lesion
Splinter haemorrhage

References
External links
Image from the New England Journal of Medicine: Endocarditis
Image from the New England Journal of Medicine: CML