Scurvy: An unusual presentation of cerebral palsy

Abstract

Scurvy is caused by prolonged severe dietary deficiency of ascorbic acid, in which the breakdown of intercellular cement substances leads to capillary hemorrhages and defective growth of fibroblasts, osteoblasts and odontoblasts, resulting in impaired synthesis of collagen, osteoid and dentine. It is characterized by hemorrhagic gingivitis, subperiosteal hemorrhages, perifollicular hemorrhages, and frequently petechial hemorrhages (especially on the feet). People with abnormal dietary habits, mental illness or physical disability are prone to develop this disease. Epiphyseal separation is known to occur in scurvy but is rarely seen now. Epiphyseal separation from the metaphysis is always through the zone of calcified cartilage, known as "scorbutic lattice", which in the radiographs is represented as "the white line of Frenkel". We report a case of multiple epiphyseal separations in a cerebral palsy child because of vitamin C deficiency. The child was treated with splintage of extremity and nutritional supplementation. All physeal separation healed completely without any deformity.

Bilateral traumatic distal femoral physeal slips: A very rare case presentation

“…Bilateral slips have been noted in scurvy in literature [4]. However, our case did not show any evident metabolic abnormality.…”

“…Multiple slips have been reported in metabolic disorders like scurvy, [4] or conditions causing generalized bone weakening like leukemia or myelodysplasia. However, we herein present one case of a six-year-old year male child with bilateral traumatic distal femoral slips with normal metabolic parameters.…”

Scurvy in pediatric age group – A disease often forgotten?

“…4). 7,18,20 The infant may have features of pseudoparalysis 21 and the presentation may have posture of "pithed…”

“…After subperiosteal bone formation, the epiphysis becomes centered on the widened metaphyses. 20,43 Separation of the epiphysis in scurvy is best treated conservatively by splintage and vitamin C supplementation and a closed or open surgical reduction of the displace depiphysis is rarely required. Complete remodeling follows in a child and residual deformity or growth disturbance are seldom reported.…”

The risk for scurvy in children with neurodevelopmental disorders

“…Literature reviewed yielded 77 cases of scurvy described in 65 published papers (Table S1), in addition to the two cases described here 1,8,9,11‐73 …”