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[A case of pseudohypoparathyroidism with intracerebral calcification]
Insights
Extensive intracerebral calcifications, particularly in the basal ganglia, can indicate pseudohypoparathyroidism. This rare condition involves low calcium and high phosphate levels, often detected via CT scans.
Area of Science:
- Neurology
- Endocrinology
- Radiology
Background:
- Intracerebral calcifications, especially in the basal ganglia, are common findings across various diseases.
- Computed tomography (CT) significantly enhances the detection of intracerebral calcifications compared to skull radiography.
Observation:
- A 41-year-old male presented with acute epidural hematoma requiring surgical intervention.
- Extensive intracerebral calcification was identified on CT scans.
- Laboratory results showed hypocalcemia and hyperphosphatemia, with physical examination revealing features consistent with pseudohypoparathyroidism.
Findings:
- The patient was diagnosed with pseudohypoparathyroidism type I based on the Ellsworth-Howard test.
- While many CT-detected basal ganglia calcifications are physiological, those also visible on radiographs may correlate with neurological symptoms and wider intracranial involvement.
Implications:
- Incidental detection of basal ganglia calcifications on CT warrants consideration for further diagnostic evaluation.
- This case highlights the importance of recognizing pseudohypoparathyroidism in patients presenting with unexplained hypocalcemia and intracranial calcifications.
Abstract:
Intracerebral calcifications, especially in the basal ganglia, are observed in many kinds of diseases. A 41-year-old man is reported, who suffered from an acute epidural hematoma and underwent surgery to remove the hematoma. We detected very extensive intracerebral calcification on CT. Laboratory findings revealed hypocalcemia and hyperphosphatemia. General physical examination revealed characteristics typical of pseudohypoparathyroidism. The patient was diagnosed as having pseudohypoparathyroidism type I by the Ellsworth-Howard test. Since the advent of CT, the incidence of basal ganglia calcification has increased. CT is 5 to 15 times more sensitive than skull radiography in the detection of intracerebral calcification. Although many pathological states can cause basal ganglia calcification, most of the calcifications which are recognized on CT scans are physiological. But in cases in which basal ganglia calcifications are recognized also on plain radiographs, various kinds of symptoms including ones of basal ganglia origin are often recognized, and calcifications often extend to regions other than basal ganglia, eg. cerebellum, thalamus, etc. Pseudohypoparathyroidism is a rare disease which presents hypocalcemia, some characteristic physical appearances, and dementia. It is important to decide whether further examinations are necessary or not, when basal ganglia calcification is recognized incidentally on CT scan.