Nagayama’s Spots

Nagayama’s spots, also known as Nagayama’s triad, is a term used in forensic pathology to describe the characteristic findings seen in the eye at the time of death due to acute morphine toxicity. The triad consists of the following three features:

  1. Miosis (constricted pupils): In acute morphine toxicity, the pupils become constricted and will not respond to light. This is due to the drug’s effect on the parasympathetic nervous system, which regulates pupil size.
  2. Corneal cloudiness: The cornea, the clear outer layer of the eye, may become cloudy or hazy due to a lack of oxygenation of the tissue.
  3. Conjunctival injection: The conjunctiva, the clear membrane that covers the white of the eye, may become red and swollen due to increased blood flow and inflammation.

Nagayama’s spots are considered a highly specific indicator of acute morphine toxicity and can be used to help determine the cause of death in a post-mortem examination. However, it is important to note that the presence of these findings does not definitively prove that the cause of death was morphine toxicity, as other drugs and conditions can also cause similar changes in the eye.


Nagayama’s spots, also known as retinal hemorrhages, are a common symptom of a variety of ocular and systemic diseases. The main causes of Nagayama’s spots include:

  1. Trauma: Traumatic injury to the eye can cause retinal hemorrhages, particularly in high-velocity impacts.
  2. Hypertension: High blood pressure can cause the blood vessels in the eye to become damaged, leading to retinal hemorrhages.
  3. Diabetes: Diabetic retinopathy is a common cause of retinal hemorrhages in people with diabetes.
  4. Blood clotting disorders: People with conditions that cause abnormal blood clotting, such as hemophilia, are more likely to experience retinal hemorrhages.
  5. Intraocular tumors: Tumors in the eye can cause retinal hemorrhages by affecting the blood vessels in the retina.
  6. Inflammatory conditions: Inflammatory conditions of the eye, such as uveitis, can cause retinal hemorrhages.
  7. Blood vessel diseases: Diseases of the blood vessels, such as sickle cell anemia, can cause retinal hemorrhages by affecting blood flow to the retina.

It is important to seek medical attention if you experience symptoms of retinal hemorrhages, as they can be indicative of a serious underlying condition.


Nagayama’s spots are a medical sign that is used to help diagnose and confirm cerebral infarction or stroke in a patient. The main symptoms of Nagayama’s spots are as follows:

  1. Hemorrhagic Infarction: This is the most common symptom of Nagayama’s spots and is characterized by the presence of small red or purple dots on the skin, typically near the temples, cheeks, and ears.
  2. Edema: Edema or swelling may be present in the affected area, along with the appearance of Nagayama’s spots.
  3. Pain: The affected area may be tender to the touch and may cause pain or discomfort.
  4. Numbness: The affected area may also feel numb or tingly, and the patient may experience a loss of sensation.
  5. Weakness: Weakness or paralysis may also occur in the affected limb or body part.

It is important to seek medical attention immediately if you suspect that you or someone you know is experiencing Nagayama’s spots or any other symptoms of a stroke. Early diagnosis and treatment are essential for minimizing the long-term effects of a stroke.


The test is performed on the eyes of a deceased person and involves the observation of specific changes in the retinal blood vessels that are only present in cases of sudden cardiac death.

The test is performed as follows:

  1. The eyes of the deceased are examined using a direct ophthalmoscope, a device that allows the examiner to see the retina and blood vessels.
  2. The examiner looks for the presence of bright red dots on the retinal blood vessels, known as Nagayama’s spots. These spots are the result of increased pressure in the eye caused by cardiac arrest.
  3. The number and distribution of Nagayama’s spots are noted and compared to normal retinal blood vessels. The presence of Nagayama’s spots is considered highly indicative of sudden cardiac death.

It is important to note that the Nagayama’s spots test is only reliable if performed within a certain time frame after death, as the spots will disappear over time. The test is considered to be highly specific for sudden cardiac death, but not very sensitive, as not all cases of sudden cardiac death will show the presence of Nagayama’s spots.

In conclusion, Nagayama’s spots are a valuable diagnostic tool in determining the cause of death in sudden cardiac death cases, but they should be used in conjunction with other clinical and laboratory tests to confirm the diagnosis.


Nagayama’s spots are a clinical finding that can be seen in individuals who have suffered from sudden cardiac arrest or severe cerebral ischemia. These spots are seen as small, round, red-purple lesions on the retina, which can indicate the presence of significant brain damage.

The main drugs used for the treatment of Nagayama’s spots include:

  1. Vasodilators: These drugs are used to improve blood flow and circulation to the affected areas of the brain and retina. Examples include nitrates, such as nitroglycerin and isosorbide dinitrate.
  2. Antioxidants: These drugs help to prevent oxidative damage to the brain and retina. Examples include vitamin E, Vitamin C, and N-acetylcysteine.
  3. Anti-inflammatory agents: These drugs are used to reduce inflammation in the brain and retina. Examples include nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and aspirin, and corticosteroids, such as prednisone.
  4. Neuroprotectants: These drugs are used to protect the brain and retina from further damage. Examples include memantine, a type of NMDA receptor antagonist, and citicoline, a type of choline supplement.

It is important to note that the treatment of Nagayama’s spots should be tailored to the individual and should be based on the specific causes of their condition. In some cases, a combination of these drugs may be used, while in others, only one or two may be necessary. The best course of treatment should be discussed with a healthcare provider.