Disclosures: Rachel Sunico, MD: No financial relationships or conflicts of interest

Case Diagnosis: This case report describes the role of vitamin C deficiency in recurrent intraparenchymal hemorrhages.

Case Description: A 78-year-old hispanic female with a recent history of right frontal lobe intraparenchymal hemorrhage (IPH) two months prior, presented with similar symptoms of acute onset altered mental status and left-sided weakness. She was readmitted for a new right frontal lobe IPH with adjacent subarachnoid hemorrhage. Her medical history was negative for hypertension, trauma, anticoagulation or antiplatelet medications.

Setting: Inpatient rehabilitationAssessment/

Results: Neurological workup did not reveal significant vascular malformations or other underlying pathologies. Comprehensive hematology workup was unremarkable except for an abnormally low level of Vitamin C of 15 mcmol/L.

Discussion: Hypovitaminosis C (scurvy) is a present day rarity since vitamin C is readily abundant in a regular diet or as dietary supplements. Vitamin C is necessary in the proper formation of collagen. Hypovitaminosis C may lead to fragile tissue and impaired blood vessel integrity. Scurvy may still be prevalent in gastrointestinal system disorders, alcohol use, and malabsorption. Classically reported symptoms of scurvy include fatigue, perifollicular hemorrhages, follicular hyperkeratosis, ecchymosis, hemarthrosis, and dental disease. Scurvy has also been reported to cause anemia/hemolysis, seizures, gastrointestinal bleeding, and congestive heart failure. Symptoms of scurvy typically manifest when vitamin C levels are less than 11 mcmol/L. While decreased endothelial health of intracerebral vessels can lead to hemorrhage, the role of hypovitaminosis C as a contributing factor to intracranial hemorrhage is poorly described in literature.

Conclusion: Hypovitaminosis C may cause impaired endothelial integrity and should be considered as a possible contributing factor in more serious conditions such as intracranial hemorrhage without other clear etiology.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/vitamin-c-deficiency-in-recurrent-intraparenchymal-hemorrhages-a-case-report/