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Images in Neurology
February 2004

Extensive Intracranial Bilateral Symmetrical Calcification Secondary to Hypoparathyroidism

Arch Neurol. 2004;61(2):281. doi:10.1001/archneur.61.2.281

A 77-year-old woman with a history of dementia, hypothyroidism secondary to thyroidectomy, and seizure disorder for 20 years was brought in by her family for tonic-clonic seizures and loss of consciousness. Her medications included phenytoin and levothyroxine. She had no history of cocaine abuse or alcohol dependency. Her vital signs were stable, and a physical examination revealed slightly pale conjunctivae, a neck scar, and mild epigastric tenderness. She was oriented only to herself. The rest of the neurologic examination findings were unremarkable. Blood tests showed a calcium level of 5.1 mg/dL (1.27 mmol/L), a phosphate level of 5.7 mg/dL, a serum albumin level of 4.1 mg/dL, and a serum parathyroid hormone level of less than 1.0 pg/mL (<0.12 pmol/L) (reference range, 10-65 pg/mL [1.1-6.3 pmol/L]). The serum free thyroxine level was normal. Noncontrast computed tomography of the head showed extensive bilateral symmetrical calcification, more impressive in the cerebellum, basal ganglia, and periventricular region (Figure 1), probably secondary to undiagnosed chronic hyoparathyroidism postthyroidectomy 20 years earlier. Chronic hypoparathyroidism syndrome is characterized by the presence of extrapyramidal signs (dyskinesia, choreiform and athetotic movements, tremors, and cogwheel rigidity), cerebellar manifestations (eg, dysarthia and ataxia), psychosis, and epilepsy.1,2 In this patient, there was only a history of seizure disorder, without other signs or symptoms.

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