Six cases of infantile intracranial hemorrhage due to vitamin K deficiency

Abstract

As a cause of intracranial hemorrhage in late newborns and early infants, vitamin K deficiency has attracted attention for several years. We have analysed clinical courses and follow-up CT films of six cases of intracranial hemorrhage due to vitamin K deficiency encountered since we introduced a CT scanner in our hospital. In spite of appropriate treatment, the prognosis in these cases was not satisfactory, and CT films showed highly characteristic findings. Surgical treatment was performed in two cases; the other four cases were given only medical treatment. CT films taken immediately after the onset showed perifocal low density areas due to brain edema and secondary cerebral ischemia. In some cases, this abnormality was observed in almost all of the affected hemisphere, sometimes also in the contralateral hemisphere. Follow-up of CT films showed irregularly scattered low density areas of various size in the subcortical and periventricular area, accompanied by absorption of the hematoma and reduction of the brain edema. These findings seemed to be compatible with the subcortical or periventricular leukomalacia reported by Takashima and Taboada et al. These occur because of imbalance between the rapid growth of the cortex and the immature minute arterial architecture of the subcortical and subependymal layers, which leads to a lowering of tolerance to anoxia. These processes cause unexpectedly severe damage to brain tissue. From this standpoint, the prognosis of intracranial hemorrhage due to vitamin K deficiency is not favorable even when an appropriate treatment is given. It is important, therefore, to recognize the significance of prophylaxis. We support the prophylactic administration of vitamin K to newborns, suggested by the research group of the Ministry of Health and Welfare, and hope that a screening test will be developed to detect the child at risk. © 1986, The Japanese Society of Child Neurology. All rights reserved.