Focal neurologic symptoms in hypercalcemia

Area of Science:

• Endocrinology
• Neurology
• Internal Medicine

Background:

• Primary hyperparathyroidism is a common endocrine disorder.
• Hypercalcemia, elevated serum calcium, can manifest with diverse symptoms.
• Neurological manifestations of hypercalcemia are less commonly documented.

Observation:

• A patient presented with moderate hypercalcemia (13.2 mg/100 ml) due to primary hyperparathyroidism.
• Symptoms included fatigue, depression, thirst, polyuria, and focal neurological deficits (amaurosis fugax, anomia, dysesthesias, transient ischemic attack).
• No structural central nervous system abnormalities were identified.

Findings:

• Neurological signs and symptoms resolved upon reduction of serum calcium levels to 9.8 mg/100 ml.
• Symptoms did not recur during a 30-month follow-up period.
• The resolution of focal neurological deficits correlated with calcium normalization.

Implications:

• This case highlights an uncommon association between hypercalcemia and focal neurological disease.
• The patient's presentation suggests a potential vascular etiology for neurological symptoms in hypercalcemia.
• Further research is warranted to elucidate the pathophysiologic mechanisms linking hypercalcemia and vascular events.