Factor X deficiency is a rare coagulation defect that can result in several hemorrhagic manifestations including central nervous system hematomas in infants and children. In this case report, we present computed tomography (CT) and magnetic resonance (MR) imaging findings of bilateral chronic subdural hematomas due to factor X deficiency. Cranial CT and MR imaging in a hypoactive 7-month-old male infant with right hemiparesis revealed bilateral chronic subdural hematomas at different stages. Laboratory findings showed a severe factor X deficiency, with a level of 0.7%. After fresh frozen plasma replacement, the patient was operated and the large hematoma on the left side evacuated. The patient recovered uneventfully and remained asymptomatic during the 1-year follow-up.

1.
Jayawant S, Rawlinson A, Gibbon F, Price J, Schulte J, Sharples P, Sibert JR, Kemp AM: Subdural haemorrhages in infants: population-based study. BMJ 1998;317:1558–1561.
2.
Akman CI, Cracco J: Intrauterine subdural hemorrhage. Dev Med Child Neurol 2000;42:843–846.
3.
Barozzino T, Sgro M, Toi A, Akouri H, Wilson S, Yeo E, Blaser S, Chitayat D: Fetal bilateral subdural haemorrhages: prenatal diagnosis and spontaneous resolution by time of delivery. Prenat Diagn 1998;18:496–503.
4.
de Spirlet M, Goffinet F, Philippe HJ, Bailly M, Couderc S, Nisand I: Prenatal diagnosis of a subdural hematoma associated with reverse flow in the middle cerebral artery: case report and literature review. Ultrasound Obstet Gynecol 2000;16:72–76.
5.
de Sousa C, Clark T, Bradshaw A: Antenatally diagnosed subdural haemorrhage in congenital factor X deficiency. Arch Dis Child 1988;63:1168–1170.
6.
Misirlioglu ED, Aliefendioglu D, Bademci G, Baydar Z, Kose G, Cakmak FN: Intracranial hemorrhage due to vitamin K deficiency in infancy: clinical and radiological findings. J Neurol Sci Turk 2009;26:18–25.
7.
Katar S, Ozbek MN, Guzel A, Devecioglu C, Ecer S: Yenidoğanlarda K vitamini eksikliğine bağlı intrakranial kanama. Çocuk Sagligi ve Hastaliklari Dergisi 2006;49:296–300.
8.
Citak A, Ucsel R, Karabocuoglu M, Unüvar A, Uzel N: A rare cause of intracranial hemorrhage: factor X deficiency. Pediatr Emerg Care 2001;17:349–350.
9.
Mishra P, Naithani R, Dolai T, Bhargava R, Mahapatra M, Dixit A, Seth T, Kumar R, Saxena R: Intracranial haemorrhage in patients with congenital haemostatic defects. Haemophilia 2008;14:952–955.
10.
Thachil JV, Caswell M, Keenan R, Hayhurst C, Crooks DA, May PL, O’Brien DF: Factor X deficiency presenting as a pseudotumor. J Neurosurg 2006;104:202–205.
11.
Ermis B, Ors R, Tastekin A, Orhan F: Severe congenital factor X deficiency with intracranial bleeding in two siblings. Brain Dev 2004;26:137–138.
12.
Bowles L, Baker K, Khair K, Mathias M, Liesner R: Prophylaxis with prothrombin complex concentrate in four children with severe congenital factor X deficiency. Haemophilia 2009;15:401–403.
13.
Shah NM, Patel AP: An analysis of 8 cases of factor X deficiency. Indian J Hematol Blood Transfus 2008;24:23–25.
14.
Fujimoto Y, Aguiar PH, Carneiro JD, Martins RS, Ciquini O Jr, de Andrade AF, Manreza LA: Spontaneous epidural hematoma following a shunt in an infant with congenital factor X deficiency. Neurosurg Rev 1999;22:226–229.
15.
Herrmann FH, Auerswald G, Ruiz-Saez A, Navarrete M, Pollmann H, Lopaciuk S, Batorova A, Wulff K, Greifswald Factor X Deficiency Study Group: Factor X deficiency: clinical manifestation of 102 subjects from Europe and Latin America with mutations in the factor 10 gene. Haemophilia 2006;12:479–489.
16.
Fobben ES, Grossman RI, Atlas SW, Hackney DB, Goldberg HI, Zimmerman RA, Bilaniuk LT: MR characteristics of subdural hematomas and hygromas at 1.5 T. AJR Am J Roentgenol 1989;153:589–595.
17.
Hosoda K, Tamaki N, Masumura M, Matsumoto S, Maeda F: Magnetic resonance images of chronic subdural hematomas. J Neurosurg 1987;67:677–683.
18.
Tzioumi D, Oates RK: Subdural hematomas in children under 2 years: accidental or inflicted? A 10-year experience. Child Abuse Negl 1998;22:1105–1112.
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.