Idiopathic hypoparathyroidism as a cause of extensive intracranial calcification.

Abstract

A 60-year-old male was referred to radiology department for head CT for evaluation of seizures of recent onset. CT showed extensive symmetric bilateral calcification in caudate nucleus, putamen, thalami, cerebellum and centrum semiovale (Fig. A,B). A radiological diagnosis of Fahr’s disease was made. During hospital stay, patient developed muscular tetany. Serum calcium was found to be low (7.2 mg/dl; normal range 8.4-10.2 mg/dl). Further tests revealed low serum parathyroid hormone (PTH) level (3.60 pg/ml; normal range 15.0-68.0 pg/dl) and elevated phosphorus level. All possible causes of hypoparathyroidism were evaluated with no positive results. On the basis of clinical, hormonal and radiological findings a diagnosis of idiopathic hypoparathyroidism was made. Patient was started calcium and 1,25-dihydroxy vitamin D. Patient reported no episode of seizures during next two days of hospital stay. He was last seen at 3 months follow up with significant improvement of clinical symptoms and serum calcium level returning to normal range.