Vitamin Deficiencies
Subdural hematomas may occur in childhood with vitamin C, and K abnormalities. No reports exist of SDH with vitamin A, B, or E abnormalities. A single case related to vitamin D deficiency is discussed in the following.
The majority of papers on the association of SDH and vitamin deficiency/abnormalities relate to vitamin K. This finding may be the result of either maternal vitamin K deficiency with SDH arising in the developing fetus97 or postdelivery neonatal vitamin K deficiency known as hemorrhagic disease of the newborn (HDN). As reported by Rutty et al.,98'99 HDN may be delayed beyond the immediate postnatal period and may present with both SDH and retinal hemorrhages, mimicking nonac-cidental injury.
Only one paper related to vitamin C deficiency could be identified to date. In this report, both SDH and retinal hemorrhages are hypothesized to result from a combination of ascorbate depletion and injection of foreign protein (from vaccinations) leading to exceptionally high blood histamine level. This situation in turn was hypothesized to result in capillary fragility and venous bleeding.100
To date no definite cases of subdural hematomas occurring in children in association with vitamin D deficiency have been reported. However, a single case of a 2.5-year-old Bengali male child with rickets who underwent bilateral exploratory burr holes to both the frontal and parietal bones because of clinical suspicion of SDH has been reported, although only 15 ml of clear fluid to the left frontal burr hole was found.101
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