Disclosures: Yumi Mitsuya, MD: No financial relationships or conflicts of interest

Case Description: The patient presented to the emergency room with bilateral knee pain and reluctance to ambulate. During his evaluation, he developed sudden onset headache, a first time seizure, and a fixed left pupil. Imaging revealed acute on chronic bi-frontal epidural hematomas. He underwent emergent craniectomy and hematoma evacuation, complicated by difficulty controlling bleeding.

Setting: Tertiary care pediatric hospital.

Patient: A 10-year-old male with history of anemia Assessment/

Results: Diet history revealed a limited diet consisting of bread, noodles, and soymilk. Laboratories revealed pancytopenia, coagulopathy, and extremely low Vitamin C level of 5 umol/L. He was started on supplementation after which serum Vitamin C level quickly normalized. Subsequent cranioplasty was tolerated without significant bleeding.

Discussion: Scurvy due to vitamin C deficiency, a disease thought to be rare in developed countries, is increasingly being reported in children with severely restrictive diets, especially those with autism. Vitamin C is involved in many biologic processes including coagulation, iron absorption, catecholamine conversion, and prostaglandin metabolism. Deficiency also results in poor collagen formation leading to compromised bone, joint, and vascular integrity. Scurvy can present with nonspecific symptoms such as skin and hair changes, rash, petechial hemorrhages, purpura, arthralgias, joint swelling, limp, and refusal to walk. While intracranial bleed is one of the rare complications of Scurvy, it leads to the greatest morbidity and mortality. It is thought that depletion of pericapillary collagen in the basement membrane of blood vessels leads to increased risk of spontaneous bleed.

Conclusion: Scurvy, while rare, is a condition that is still encountered in the pediatric population, and should be considered in the differential diagnosis for spontaneous intracranial hemorrhage in patients. Screening for restrictive eating habits during routine Well Child visits may help to identify those at risk of nutritional deficiencies, leading to prompt testing and early treatment which could mitigate clinical symptoms and potentially devastating consequences.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-epidural-hematomas-in-a-child-with-scurvy-a-case-report/