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Xu H, Qin H, Zhong S, He Q, Chen S, Guan M. Hyperparathyroidism and cerebral calcifications:a case report. Neurocase 2022; 28:226-230. [PMID: 35503973 DOI: 10.1080/13554794.2022.2071627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The evidence of hyperparathyroidism associated with cerebral calcifications is rare. We report a case with primary hyperparathyroidism (PHPT) and cerebral calcifications. A 63-year-old female patient with a history of hypertension presented to the neurology department due to bradykinesia and declining memory for one year. Cranial CT and magnetic resonance imaging (MRI) scan revealed symmetrical calcifications in the basal ganglia, dentate nucleus of the cerebellum and in the gray and white matter junction. In the literature review, a total of 6 patients with PHPT had cerebral calcifications. Parathyroidectomy may provide a significant remission of cerebral calcifications in a patient with PHPT.
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Affiliation(s)
- Hongyan Xu
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China.,Wuzhou Hospital of Youjiang Medical University for Nationalities, Baise, Wuzhou, Guangxi, China
| | - Haoqiang Qin
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China.,Wuzhou Hospital of Youjiang Medical University for Nationalities, Baise, Wuzhou, Guangxi, China
| | - Shengwu Zhong
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China.,Wuzhou Hospital of Youjiang Medical University for Nationalities, Baise, Wuzhou, Guangxi, China
| | - Qitan He
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China.,Wuzhou Hospital of Youjiang Medical University for Nationalities, Baise, Wuzhou, Guangxi, China
| | - Shaohua Chen
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China.,Wuzhou Hospital of Youjiang Medical University for Nationalities, Baise, Wuzhou, Guangxi, China
| | - Mingjian Guan
- Department of Neurology, People's Hospital of Wuzhou, Wuzhou, Guangxi, China.,Wuzhou Hospital of Youjiang Medical University for Nationalities, Baise, Wuzhou, Guangxi, China
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Wadia P, Mishal B, Kachhadiya K, Chandalia S, Bhansali M. Hyperparathyroidism: A rare cause of worsening of parkinsonism. ANNALS OF MOVEMENT DISORDERS 2020. [DOI: 10.4103/aomd.aomd_28_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Augusto CMG, de Morais NS, Santana RP, de Almeida MOP. PARKINSONISM AS AN ATYPICAL MANIFESTATION OF PRIMARY HYPERPARATHYROIDISM. AACE Clin Case Rep 2019; 5:e244-e246. [PMID: 31967044 DOI: 10.4158/accr-2018-0504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 02/04/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE Primary hyperparathyroidism (PHPT) occurs as a result of hyperfunctional parathyroid glands resulting in an elevation of serum calcium levels. The association between hypoparathyroidism and parkinsonism have been frequently reported in the literature, while evidence of hyperparathyroidism associated with parkinsonism is rare. METHODS The present study reports a case of a patient that had PHPT and developed symptoms of parkinsonism. RESULTS A 75-year-old female patient with a history of diabetes mellitus, dyslipidemia, and systemic arterial hypertension presented to the emergency room due to unexplained drowsiness. Her serum calcium at the time was 14.2 mg/dL. A cervical ultrasound was performed, and the presence of a 2.5 × 1.9-cm nodule in the left lower parathyroid region was identified. Three days later, scintigraphy with the use of sestamibi showed an increased capture of the marker in the same region, suggesting parathyroid hyperfunction. During hospitalization, the patient developed symptoms of parkinsonism. A left inferior parathyroidectomy was performed, with normalization of serum calcium levels and a remission of drowsiness, in addition to a significant improvement in parkinsonian symptoms. The patient remained free of parkinsonism over 3 years of follow up. CONCLUSION Parathyroidectomy can provide a significant remission of parkinsonism in a patient with PHPT. Even though it is rare, the relation between parkinsonism and PHPT exists.
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Issa R, Barakat A, Salman R, Naffaa L. Vein of Galen Malformation, a cause of Intracranial Calcification: Case Report and Review of Literature. J Radiol Case Rep 2019; 13:13-18. [PMID: 31565173 DOI: 10.3941/jrcr.v13i3.3456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Intracranial calcifications in the pediatric population can have many etiologies including neoplastic, infectious, neurodegenerative, metabolic, or cerebrovascular abnormalities. We present the case of a 2-year-old boy with vein of Galen malformation, a rare cause of intracranial calcifications with a review of literature.
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Affiliation(s)
- Rayane Issa
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Andrew Barakat
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rida Salman
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lena Naffaa
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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5
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Ischemic stroke in the setting of secondary hyperparathyroidism due to vitamin D deficiency. J Neuroradiol 2018; 45:391-393. [DOI: 10.1016/j.neurad.2018.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/21/2018] [Accepted: 07/08/2018] [Indexed: 11/18/2022]
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Ohya Y, Osaki M, Sakai S, Kimura S, Yasuda C, Ago T, Kitazono T, Arakawa S. A case of hyperparathyroidism-associated parkinsonism successfully treated with cinacalcet hydrochloride, a calcimimetic. BMC Neurol 2018; 18:62. [PMID: 29734949 PMCID: PMC5937038 DOI: 10.1186/s12883-018-1067-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/02/2018] [Indexed: 01/10/2023] Open
Abstract
Background Some metabolic disorders, including abnormal calcium metabolism, can develop and worsen parkinsonism. However, whether hyperparathyroidism can cause parkinsonism remains controversial. Case presentation An 83-year-old woman with a history of right thalamic hemorrhage and drug-induced parkinsonism, was admitted due to worsening of parkinsonian symptoms including mask-like face, bradykinesia, freezing of gait, and rigidity. She had been diagnosed with autoimmune hepatitis and was being treated with prednisolone. Examinations revealed hypercalcemia (14.3 mg/dL) with an increased level of intact parathyroid hormone (iPTH) (361 pg/mL). Her symptoms were resistant to some additional anti-parkinsonian drugs; however, cinacalcet hydrochloride, a calcimimetic for the treatment of secondary hyperparathyroidism, normalized levels of serum calcium and iPTH, and remarkably improved her symptoms. Conclusions In the present case, we speculate that hypercalcemia probably due to secondary hyperparathyroidism that had developed during steroid therapy deteriorated the parkinsonism.
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Affiliation(s)
- Yuichiro Ohya
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan. .,Department of Cerebrovascular Medicine, Kyushu Central Hospital, 3-23-1 Shiobaru, Minami-ku, Fukuoka-shi, Fukuoka, 815-8588, Japan.
| | - Masato Osaki
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shota Sakai
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Shunsuke Kimura
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Chiharu Yasuda
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
| | - Tetsuro Ago
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takanari Kitazono
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shuji Arakawa
- Department of Cerebrovascular Medicine, Stroke Center, Steel Memorial Yawata Hospital, Kitakyushu, Japan
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Abstract
Brain calcifications may be an incidental finding on neuroimaging in normal, particularly older individuals, but can also indicate numerous hereditary and nonhereditary syndromes, and metabolic, environmental, infectious, autoimmune, mitochondrial, traumatic, or toxic disorders. Bilateral calcifications most commonly affecting the basal ganglia may often be found in idiopathic cases, and a new term, primary familial brain calcification (PFBC), has been proposed that recognizes the genetic causes of the disorder and that calcifications occurred well beyond the basal ganglia. PFBC, usually inherited in an autosomal dominant fashion, is both an intrafamilial and an interfamilial heterogeneous disorder, clinically characterized by an insidious and progressive development of movement disorders, cognitive decline, and psychiatric symptoms, but also cerebellar ataxia, pyramidal signs, and sometimes isolated seizures and headaches/migraines. Heterozygous mutations in four genes (SLC20A2, PDGFRB, PDGFB, XPR1) have recently proved to be the causes of the autosomal dominant forms of PFBC, also suggesting disrupted phosphate homeostasis as "an underlying and converging" pathophysiological mechanism. However, to date, it is not possible to anticipate with acceptable certainty any of known genetic causes of PFBC on the basis of the type, severity, pattern of distribution, or combination of movement disorders (mainly parkinsonism, with or without tremor, but also dystonia, chorea, paroxysmal kinesigenic dyskinesia, orofacial dyskinesia, and gait and speech disorders).
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Affiliation(s)
- Vladimir S Kostić
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia.
| | - Igor N Petrović
- Clinic of Neurology, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Dr Subotica 6, Belgrade, 11000, Serbia
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Savino E, Soavi C, Capatti E, Borrelli M, Vigna GB, Passaro A, Zuliani G. Bilateral strio-pallido-dentate calcinosis (Fahr's disease): report of seven cases and revision of literature. BMC Neurol 2016; 16:165. [PMID: 27608765 PMCID: PMC5015253 DOI: 10.1186/s12883-016-0693-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Accepted: 09/01/2016] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Fahr's disease is rare a neurodegenerative idiopathic condition characterized by symmetric and bilateral calcifications of basal ganglia, usually associated with progressive neuropsychiatric dysfunctions and movement disorders. The term "Fahr's syndrome" is used in presence of calcifications secondary to a specific cause, but the variability of etiology, pathogenesis, and clinical picture underlying this condition have raised the question of the real existence of a syndrome. Several classifications based on the etiology, the location of brain calcifications and the clinical presentation have been proposed. Here we describe seven clinical cases of basal ganglia calcifications, in order to search for pathognomonic features and correlations between clinical picture and imaging findings. CASES PRESENTATION The patients came to our attention for different reasons (most of them for memory/behavior disturbances); all underwent neuro-psychologic evaluation and neuro-imaging. All patients showed variable degrees of deterioration in cognitive function; anxiety and depression were frequent too, and resistant to treatment in all cases. Less frequent, but severe if present, were psychotic symptoms, with different grade of structure and emotional involvement, and always resistant to treatment. We observed only few cases of extrapyramidal disorders related to the disease itself; anyway, mild extrapyramidal syndrome occurred quite frequently after treatment with antipsychotics. CONCLUSION Based on these findings we discourage the use of the term "Fahr's syndrome", and suggest to refer to Idiopathic or Secondary basal ganglia calcification. Unlike early onset forms (idiopathic or inherited), the clinical presentation of late onset form and Secondary basal ganglia calcification seems to be really heterogeneous. Case-control studies are necessary to determine the actual significance of basal ganglia calcification in the adult population and in the elderly, in cognitive, physical and emotional terms.
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Affiliation(s)
- Elisabetta Savino
- Department of Medical Sciences, Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Via Savonarola n°9, 44100 Ferrara, Italy
| | - Cecilia Soavi
- Department of Medical Sciences, Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Via Savonarola n°9, 44100 Ferrara, Italy
| | - Eleonora Capatti
- Department of Medical Sciences, Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Via Savonarola n°9, 44100 Ferrara, Italy
| | - Massimo Borrelli
- Azienda Ospedaliero-Universitaria S. Anna Ferrara, Ferrara, Italy
| | | | - Angelina Passaro
- Department of Medical Sciences, Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Via Savonarola n°9, 44100 Ferrara, Italy
| | - Giovanni Zuliani
- Department of Medical Sciences, Section of Internal and Cardiopulmonary Medicine, University of Ferrara, Via Savonarola n°9, 44100 Ferrara, Italy
- Azienda Ospedaliero-Universitaria S. Anna Ferrara, Ferrara, Italy
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Calcificaciones cerebrales e hiperparatiroidismo primario. Cir Esp 2016; 94:e5-7. [DOI: 10.1016/j.ciresp.2015.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Revised: 07/22/2015] [Accepted: 08/01/2015] [Indexed: 11/21/2022]
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Livingston JH, Stivaros S, Warren D, Crow YJ. Intracranial calcification in childhood: a review of aetiologies and recognizable phenotypes. Dev Med Child Neurol 2014; 56:612-26. [PMID: 24372060 DOI: 10.1111/dmcn.12359] [Citation(s) in RCA: 120] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/31/2013] [Indexed: 12/24/2022]
Abstract
Intracranial calcification (ICC) is a common finding on neuroimaging in paediatric neurology practice. In approximately half of all cases the calcification occurs in damaged, neoplastic, or malformed brain. For the large number of other disorders in which ICC occurs, no common pathogenetic mechanism can be suggested. Congenital infection, particularly with cytomegalovirus, accounts for a significant proportion of all cases. However, some genetic diseases, in particular Aicardi-Goutières syndrome, Band-like calcification, and RNASET2-related disease, may mimic congenital infection; therefore, a full consideration of the radiological and clinical features is necessary before concluding that congenital infection is the cause. In some disorders calcification is a universal finding, in others it is a frequent occurrence, and in some it is only an occasional finding. Characteristic patterns of calcification are seen in a number of conditions, and a systematic approach to the identification and description of radiological findings, taken together in the context of the clinical scenario, allows a diagnosis to be made in many cases. Nonetheless, there remain a number of presumed genetic disorders associated with ICC for which the underlying molecular cause has not yet been identified.
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Affiliation(s)
- John H Livingston
- Department of Paediatric Neurology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
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11
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De Rosa A, Rinaldi C, Tucci T, Pappatà S, Rossi F, Morra VB, Faggiano A, Colao A, De Michele G. Co-existence of primary hyperparathyroidism and Parkinson's disease in three patients: an incidental finding? Parkinsonism Relat Disord 2011; 17:771-3. [PMID: 21733736 DOI: 10.1016/j.parkreldis.2011.04.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2011] [Revised: 04/06/2011] [Accepted: 04/21/2011] [Indexed: 11/29/2022]
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12
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Yee AH, Rabinstein AA. Neurologic presentations of acid-base imbalance, electrolyte abnormalities, and endocrine emergencies. Neurol Clin 2010; 28:1-16. [PMID: 19932372 DOI: 10.1016/j.ncl.2009.09.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Accurate identification of nervous system dysfunction is vital in the assessment of any multisystem disorder. The neurologic manifestations of acid-base disturbances, abnormal electrolyte concentrations, and acute endocrinopathies are protean and typically determined by the acuity of the underlying derangement. Detailed history and physical examination may guide appropriate laboratory testing and lead to prompt and accurate diagnosis. Neurologic manifestations of primary and secondary systemic disorders are frequently encountered in all subspecialties of medicine. This article focuses on key neurologic presentations of respiratory and metabolic acid-base derangements and potentially life-threatening endocrinopathies.
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Affiliation(s)
- Alan H Yee
- Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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13
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Braverman ER, Chen TJH, Chen ALC, Arcuri V, Kerner MM, Bajaj A, Carbajal J, Braverman D, Downs BW, Blum K. Age-related increases in parathyroid hormone may be antecedent to both osteoporosis and dementia. BMC Endocr Disord 2009; 9:21. [PMID: 19825157 PMCID: PMC2768728 DOI: 10.1186/1472-6823-9-21] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Accepted: 10/13/2009] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Numerous studies have reported that age-induced increased parathyroid hormone plasma levels are associated with cognitive decline and dementia. Little is known about the correlation that may exist between neurological processing speed, cognition and bone density in cases of hyperparathyroidism. Thus, we decided to determine if parathyroid hormone levels correlate to processing speed and/or bone density. METHODS The recruited subjects that met the inclusion criteria (n = 92, age-matched, age 18-90 years, mean = 58.85, SD = 15.47) were evaluated for plasma parathyroid hormone levels and these levels were statistically correlated with event-related P300 potentials. Groups were compared for age, bone density and P300 latency. One-tailed tests were used to ascertain the statistical significance of the correlations. The study groups were categorized and analyzed for differences of parathyroid hormone levels: parathyroid hormone levels <30 (n = 30, mean = 22.7 +/- 5.6 SD) and PTH levels >30 (n = 62, mean = 62.4 +/- 28.3 SD, p <or= 02). RESULTS Patients with parathyroid hormone levels <30 showed statistically significantly less P300 latency (P300 = 332.7 +/- 4.8 SE) relative to those with parathyroid hormone levels >30, which demonstrated greater P300 latency (P300 = 345.7 +/- 3.6 SE, p = .02). Participants with parathyroid hormone values <30 (n = 26) were found to have statistically significantly higher bone density (M = -1.25 +/- .31 SE) than those with parathyroid hormone values >30 (n = 48, M = -1.85 +/- .19 SE, p = .04). CONCLUSION Our findings of a statistically lower bone density and prolonged P300 in patients with high parathyroid hormone levels may suggest that increased parathyroid hormone levels coupled with prolonged P300 latency may become putative biological markers of both dementia and osteoporosis and warrant intensive investigation.
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Affiliation(s)
- Eric R Braverman
- Department of Neurological Surgery, Weill Cornell College of Medicine, New York, New York, USA
- Path Medical Research Foundation, 304 Park Ave South, 6th Floor, NY, NY 10010, USA
| | - Thomas JH Chen
- Department of Health and Occupational Safetly, Chang Jung Christian University, Taiwan, Republic Of China
| | - Amanda LC Chen
- Department of Engineering, Chang Jung Christian University, Taiwan, Republic Of China
| | - Vanessa Arcuri
- Department of Neurological Research, Path Research Foundation, New York, NY, USA
| | - Mallory M Kerner
- Department of Neurological Research, Path Research Foundation, New York, NY, USA
| | - Anish Bajaj
- Department of Neurological Research, Path Research Foundation, New York, NY, USA
| | - Javier Carbajal
- Department of Neurological Research, Path Research Foundation, New York, NY, USA
| | - Dasha Braverman
- Department of Neurological Research, Path Research Foundation, New York, NY, USA
| | - B William Downs
- Department of Molecular Nutrition & Nutrigenomics, LifeGen, Inc La Jolla, California, USA
| | - Kenneth Blum
- Department of Neurological Research, Path Research Foundation, New York, NY, USA
- Department of Molecular Nutrition & Nutrigenomics, LifeGen, Inc La Jolla, California, USA
- Department of Physiology and Pharmacology, Wake Forest University School of Medicine, Winston -Salem, NC, USA
- Department of Psychiatry, School of Medicine, University of Florida, Gainesville, FL, USA
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Brunoni AR, Nakata AC, Tung TC, Busatto GF. Vitamin D-Resistant Rickets Type II-A, Basal Ganglia Calcification, and Catatonia: A Casual or Causal Relationship? PSYCHOSOMATICS 2009; 50:420-4. [DOI: 10.1176/appi.psy.50.4.420] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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Abstract
Bilateral almost symmetric calcification involving striatum, pallidum with or without deposits in dentate nucleus, thalamus and white matter is reported from asymptomatic individuals to a variety of neurological conditions including autosomal dominant inheritance to pseudo-pseudohypoparathyroidism. While bilateral striopallidodentate calcinosis is commonly referred to as 'Fahr's disease' (a misnomer), there are 35 additional names used in the literature for the same condition. Secondary bilateral calcification is also reported in a variety of genetic, developmental, metabolic, infectious and other conditions. In autosomal dominant or sporadic bilateral striopallidodentate calcinosis no known calcium metabolism abnormalities are known to date. Clinically, parkinsonism or other movement disorders appear to be the most common presentation, followed by cognitive impairment and ataxia. When presence of movement disorder, cognitive impairment and ataxia are present, a computed tomography scan of the head should be considered to rule-in or rule-out calcium deposits. Calcium and other mineral deposits cannot be linked to a single chromosomal locus. Further genetic studies to identify the chromosomal locus for the disease are in progress.
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Affiliation(s)
- Bala V Manyam
- Department of Neurology, Scott & White Clinic, Plummer Movement Disorders Center, The Texas A&M University System Health Science Center College of Medicine, Temple, TX 76508, USA.
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16
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Seyahi N, Apaydin S, Sariyar M, Serdengecti K, Erek E. Intracranial calcification and tumoural calcinosis during vitamin D therapy. Nephrology (Carlton) 2004; 9:89-93. [PMID: 15056268 DOI: 10.1111/j.1440-1797.2003.00237.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Extraskeletal calcifications are frequently observed in patients with chronic renal failure. However, clinically, they usually remain silent. In this report, we describe two patients with massive extraskeletal calcifications that caused significant morbidity. The first patient had tumoural calcification located on the shoulder and the second patient had severe neurological symptoms caused by intracranial calcifications. High calcium phosphorus product and severe secondary hyperparathyroidism were present in both patients. Furthermore, they both received inappropriately high doses of active vitamin D, even though they failed to respond to this therapy. We suggest to monitor closely the calcium, phosphorus and parathyroid hormone levels during calcitriol therapy and to perform parathyroidectomy, without delay, in patients who were resistant to calcitriol.
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Affiliation(s)
- Nurhan Seyahi
- Department of Nephrology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey.
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18
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Nagaratnam N, Plew JD. Extensive intracranial calcification secondary to hypoxia, presenting with dyspraxic gait. AUSTRALASIAN RADIOLOGY 1998; 42:232-3. [PMID: 9727250 DOI: 10.1111/j.1440-1673.1998.tb00501.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The imaging appearances of a case of extensive intracranial calcification presenting with dyspraxic gait are described. Computed tomography showed bilateral calcification in the anterior, posterior and central watershed areas and in the basal ganglia. It is believed that the changes are secondary to previous hypoxaemia and hypotension, and that subsequent development of the symptoms is due to calcification in the dystrophic tissue.
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Affiliation(s)
- N Nagaratnam
- Department of Medicine (Geriatrics), Blacktown-Mt Druitt Health Service, Blacktown, New South Wales, Australia
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Fénelon G, Gray F, Paillard F, Thibierge M, Mahieux F, Guillani A. A prospective study of patients with CT detected pallidal calcifications. J Neurol Neurosurg Psychiatry 1993; 56:622-5. [PMID: 8509774 PMCID: PMC489610 DOI: 10.1136/jnnp.56.6.622] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
In a prospective study pallidal calcification was detected in 30 of 1478 (2%) adult patients, on CT brain scans. In 8 cases (26%), the calcifications were detected either years after, or during the course of, conditions known to cause basal ganglia calcification, including AIDS in four cases. Eight patients (three with AIDS) had disturbances of calcium and phosphorus metabolism. It was concluded that: a) pallidal calcification is not uncommon and aetiological factors may be recognised more often than previously reported; b) AIDS is emerging as a significant cause of pallidal calcification in young adults, and c) in AIDS and other conditions, abnormal calcium and phosphate metabolism may act in conjunction with local vascular changes.
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Affiliation(s)
- G Fénelon
- Service des maladies du système nerveux, Hôpital Tenon, Paris, France
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20
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Abstract
We report the study of four children with bilateral basal ganglia calcifications (BGC) visualized on CT scan. Epilepsy was the clinical manifestation of three patients whose laboratory investigation revealed abnormal calcium metabolism. The first aim of this paper is to call attention to a treatable entity that can cause epileptic syndromes in infancy and childhood. The second purpose is to review the literature comparing with our fourth child who presented encephalopathy with BGC.
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Affiliation(s)
- M M Guerreiro
- Departamento de Neurologia, Faculdade de Ciências Médicas (FCM), Universidade Estadual de Campinas (UNICAMP), Brasil
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21
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Abstract
Sixteen patients with myotonic dystrophy underwent CT examination of the skull, and measurement of bone mineral density at lumbar spine and hip by dual-photon absortiometry. The results were compared with those of 20 normal subjects of similar age and sex distribution. Hyperostosis of the calvarium, and increased bone mineral density at lumbar vertebrae were observed. One case showed basal ganglia calcification associated with hyperparathyroidism secondary to deficiency of vitamin D. In the other 15 patients, studies of calcium metabolism were normal. There results suggest the existence of generalized hyperostotic potential in patients with myotonic dystrophy.
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Affiliation(s)
- J R Rodriguez
- Neurology Service, Galicia General Hospital, Santiago de Compostela University, Spain
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Morgante L, Vita G, Meduri M, Di Rosa AE, Galatioto S, Coraci MA, Di Perri R. Fahr's syndrome: local inflammatory factors in the pathogenesis of calcification. J Neurol 1986; 233:19-22. [PMID: 3950660 DOI: 10.1007/bf00313985] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Three cases of Fahr's syndrome are described. All patients had disturbances of calcium metabolism and had had a meningoencephalitis in childhood. It is suggested that gliovascular changes, induced by cerebral inflammation, can later facilitate the occurrence of calcification of the striopallidodentate system when abnormality of calcium metabolism develops.
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Heyman SN, Michaeli J, Brezis M, Gozlan L, Lernau O. Primary hyperparathyroidism presenting as cervical myelopathy. Am J Med Sci 1986; 291:112-4. [PMID: 3946466 DOI: 10.1097/00000441-198602000-00006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Quadriplegia as a presenting syndrome in a case of primary hyperparathyroidism is reported. The clinical picture was misdiagnosed as a space-occupying lesion in the cervical spinal canal, for which an unnecessary laminectomy was performed. The neurologic deficits disappeared following the removal of a parathyroid adenoma. The neurologic presentations of hyperparathyroidism are reviewed and discussed.
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Abstract
Of 7040 patients who were examined with CT scan for various reasons, 72 (1.02%) showed symmetrical intracranial calcifications. On the basis of the extent of the calcifications, the patients were divided into 3 groups of which the first (10 cases), with extensive calcifications, showed clear findings of hypoparathyroidism; the second (4 cases), with less extensive calcifications, showed borderline laboratory findings and the third (58 cases), with calcifications only in the internal part of the globus pallidus, had no relation to any disturbance of the parathyroid function. The limited percentage (4.2%) of calcifications detected by ordinary cranial X-rays was discussed as compared to those diagnosed by CT scan; this is due to the weakening of the relationship which existed in the past between hypoparathyroidism and calcifications. Patients with extensive calcifications do not seem to have a significantly higher proportion of neurological impairment (35.8%) than patients who showed limited calcifications (34.5%). On the other hand, patients with extensive calcifications showed more frequent mental disorders (50%) compared to those who showed limited calcifications (34.5%). The proportion of mental disorders is still higher in patients with dilatation of the subarachnoid spaces (56.7%) compared to those who do not show dilatation (23.8%). Finally, of the 72 patients with calcifications, 15 (20.8%) showed extrapyramidal syndrome, possibly due to calcium salt deposits in the metasynaptic dopamine receptors while 13 (18%) were taking anticonvulsant drugs which, apart from influencing the metabolism of calcium, also influence the activity of alkaline phosphatase and are involved in the creation of calcifications.
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Vakaet A, Rubens R, de Reuck J, vander Eecken H. Intracranial bilateral symmetrical calcification on CT-scanning. A case report and a review of the literature. Clin Neurol Neurosurg 1985; 87:103-11. [PMID: 4028584 DOI: 10.1016/0303-8467(85)90106-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The case of a 57-year-old woman with idiopathic hypoparathyroidism is presented. A CT-scan showed extensive bilateral symmetrical calcification in the region of the basal ganglia, nuclei of the cerebellum and the cerebral and cerebellar white matter. A review of the literature showed that bilateral symmetrical calcification detected by CT is usually small in extent and is most often confined to the globus pallidus. It is most commonly found in patients older than 50 years, who only rarely have symptoms associated with it. The finding is, though, non-specific and may occur in a variety of pathological conditions both with and without an aetiological relationship. Further study of the cerebral parathormone responsive adenylate cyclase enzyme proves hopeful to elucidate the aetiology of idiopathic bilateral symmetrical calcification.
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Yanagihara R, Garruto RM, Gajdusek DC, Tomita A, Uchikawa T, Konagaya Y, Chen KM, Sobue I, Plato CC, Gibbs CJ. Calcium and vitamin D metabolism in Guamanian Chamorros with amyotrophic lateral sclerosis and parkinsonism-dementia. Ann Neurol 1984; 15:42-8. [PMID: 6546847 DOI: 10.1002/ana.410150108] [Citation(s) in RCA: 83] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We evaluated 16 Guamanian Chamorros with amyotrophic lateral sclerosis and 33 patients with parkinsonism-dementia for disturbances of calcium and vitamin D metabolism. The serum immunoreactive parathyroid hormone level was mildly elevated in 6 patients with amyotrophic lateral sclerosis and in 5 patients with parkinsonism-dementia. There were significant positive correlations between serum immunoreactive parathyroid levels and duration of illness in male patients with motor neuron disease, but not in female patients or in patients with parkinsonism-dementia. Intestinal absorption of calcium, as assessed by serum and urinary activity of calcium 47 following oral administration, was decreased in 2 patients with amyotrophic lateral sclerosis and in 4 patients with parkinsonism-dementia, all of whom had low levels of serum 1,25-dihydroxyvitamin D. Reductions in cortical bone mass were striking in patients with motor neuron disease. A significant negative correlation was found between the percentage of cortical area of the second metacarpal bone and muscle atrophy and weakness, and significant positive correlations were found between degree of immobility and ratio of urinary hydroxyproline to creatinine in patients with amyotrophic lateral sclerosis and parkinsonism-dementia. In general, abnormalities in calcium metabolism were subtle. Thus, if the demonstrated deposition of metals, particularly calcium and aluminum, in central nervous system tissues of Guamanians with these two conditions is a cause of the diseases and of the early appearance of neurofibrillary tangles in neurons, the accumulation has apparently occurred long before onset of symptoms, and detectable abnormalities of calcium and vitamin D metabolism may already have been corrected.
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Vles JS, Lodder J, van der Lugt PJ. Clinical significance of basal ganglia calcifications detected by ct (a retrospective study of 33 cases). Clin Neurol Neurosurg 1981; 83:253-6. [PMID: 6276074 DOI: 10.1016/0303-8467(81)90048-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
In a retrospective study 2015 CT scans were studied for the presence of basal ganglia calcifications. These were discovered in 33 cases. No abnormalities in serum calcium or phosphate levels or any other specific clinical symptoms related to these calcifications were found. It is concluded that basal ganglia calcifications casually detected by CT generally have no clinical significance.
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