Extensive Intracranial Calcification in aCase of Hypoparathyroidism Which Presented With Generalized Tonic-Clonic Seizure: A Case Report
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Abstract
Hypoparathyroidism is an endocrine disorder that can be congenital or acquired. Generally, hypoparathyroidism is characterized by hypocalcemia, hyperphosphatemia, and low or abnormal levels of Parathyroid Hormone (PTH). It can be asymptomatic or symptomatic. The symptoms include seizures, paresthesia, depression, psychosis, extrapyramidal manifestations, and increased intracranial pressure. In this case study, we reported a 40-year- old male patient who was admitted to the emergency department with generalized tonic- clonic movements and urine incontinency. Laboratory investigations revealed hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels and in paraclinical studies, including Electroencephalography (EEG) and brain CT-scan, despite normal EEG, extensive intracranial calcification involving the basal ganglia, thalamus, white matter of the cerebral hemispheres, and subcortical area of the frontal and parietal lobes were observed on CT-scan.
[1] Al-Azem H, Khan AA. Hypoparathyroidism. Best Practice & Research Clinical Endocrinology & Metabolism. 2012; 26(4):517-22. [DOI:10.1016/j.beem.2012.01.004] [PMID]
[2] Zisimopoulou V, Siatouni A, Tsoukalos G, Tavernarakis A, Gatzonis S. Extensive bilateral intracranial calcifications: A case of iatrogenic hypoparathyroidism. Case Reports in Medicine. 2013; 2013:932184 [DOI:10.1155/2013/932184] [PMID] [PMCID]
[3] Venugopal A, Acharya P, Kishore MS. Extensive intracranial calcification in idiopathic hypoparathyroidism: Rare presentation in an adolescent. Indian Journal of Radiology and Imaging. 2006; 16(2):181. [DOI:10.4103/0971-3026.29083]
[4] Rizvi I, Ansari NA, Beg M, Shamim D. Widespread intracranial calcification, seizures and extrapyramidal manifestations in a case of hypoparathyroidism. North American Journal of Medical Sciences. 2012; 4(8):369-72. [DOI:10.4103/1947-2714.99523] [PMID] [PMCID]
[5] Aggarwal S, Kailash S, Sagar R, Tripathi M, Sreenivas V, Sharma R, et al. Neuropsychological dysfunction in idiopathic hypoparathyroidism and its relationship with intracranial calcification and serum total calcium. European Journal of Endocrinology. 2013; 168(6):895-903. [DOI:10.1530/EJE-12-0946] [PMID]
[6] Stelmasiak Z, Tarach JS, Nowicka-Tarach BM, Mitosek-Szewczyk K, Drop A. Idiopathic hypoparathyroidism with intracranial calcifications and dominant skin manifestations. Medical Science Monitor. 2000; 6(1):145-50. [PMID]
[7] Fowler WM Jr, Ling S. Convulsions and papilledema in a child with idiopathic hypoparathyroidism. California Medicine. 1961; 95(3):180-2. [PMID] [PMCID]
[8] Rubin MR, Bilezikian JP. Hypoparathyroidism: Clinical features, skeletal microstructure and parathyroid hormone replacement. Arquivos Brasileiros de Endocrinologia & Metabologia. 2010; 54(2):220-6. [DOI:10.1590/S0004-27302010000200019] [PMID] [PMCID]
[9] Verma I, Gupta R, Singh S, Warkade D, Subhash N, Bose CH. Bilateral symmetrical basal ganglia calcification with atypical presentation: A case series. 2016. https://www.semanticscholar.org/paper/ Bilateral-Symmetrical-Basal-Ganglia-Calcification-A-Verma-Gupta/ 0b1d8f05221aeff42c470f42a0148fbd8e5c5db5
[10] Moushumi L, Rajarshi M. Primary hypoparathyroidism misdiagnosed as epilepsy - a case report: Seizures, hypocalcemia and cerebral calcification. The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine. 2014; 25(2):195-8. [PMID] [PMCID]
[11] Verulashvili IV, Glonti LSh, Miminoshvili DK, Maniia MN, Mdivani KS. Basal ganglia calcification: Clinical manifestations and diagnostic evaluation. Georgian Medical News. 2006; 140:39-43. [PMID]
[12] Basak RC. A case report of basal ganglia calcification: A rare finding of hypoparathyroidism. Oman Medical Journal. 2009; 24(3):220-2. [DOI:10.5001/omj.2009.44] [PMID] [PMCID]
[13] Koller WC, Cochran JW, Klawans HL. Calcification of the basal ganglia: Computerized tomography and clinical correlation. Neurology. 1979; 29(3):328-33. [DOI:10.1212/WNL.29.3.328] [PMID]
[14] Ehsaei MR, Abouei Mehrizi MA, Firouz F. Extensive intracranial calcification in a case of hypoparathyroidism: Case report. Iranian Journal of Neurosurgery. 2017; 2(4):22-4. [DOI:10.29252/irjns.2.4.22]
[15] Sabau M, Comanescu A, Maghiar T, Dinulescu D. Hypoparathyroidism diagnosed by neurological signs and widespread intracerebral calcifications. Romanian Journal of Neurology. 2010; 9(1):44-50. [DOI:10.37897/RJN.2010.1.8]
[2] Zisimopoulou V, Siatouni A, Tsoukalos G, Tavernarakis A, Gatzonis S. Extensive bilateral intracranial calcifications: A case of iatrogenic hypoparathyroidism. Case Reports in Medicine. 2013; 2013:932184 [DOI:10.1155/2013/932184] [PMID] [PMCID]
[3] Venugopal A, Acharya P, Kishore MS. Extensive intracranial calcification in idiopathic hypoparathyroidism: Rare presentation in an adolescent. Indian Journal of Radiology and Imaging. 2006; 16(2):181. [DOI:10.4103/0971-3026.29083]
[4] Rizvi I, Ansari NA, Beg M, Shamim D. Widespread intracranial calcification, seizures and extrapyramidal manifestations in a case of hypoparathyroidism. North American Journal of Medical Sciences. 2012; 4(8):369-72. [DOI:10.4103/1947-2714.99523] [PMID] [PMCID]
[5] Aggarwal S, Kailash S, Sagar R, Tripathi M, Sreenivas V, Sharma R, et al. Neuropsychological dysfunction in idiopathic hypoparathyroidism and its relationship with intracranial calcification and serum total calcium. European Journal of Endocrinology. 2013; 168(6):895-903. [DOI:10.1530/EJE-12-0946] [PMID]
[6] Stelmasiak Z, Tarach JS, Nowicka-Tarach BM, Mitosek-Szewczyk K, Drop A. Idiopathic hypoparathyroidism with intracranial calcifications and dominant skin manifestations. Medical Science Monitor. 2000; 6(1):145-50. [PMID]
[7] Fowler WM Jr, Ling S. Convulsions and papilledema in a child with idiopathic hypoparathyroidism. California Medicine. 1961; 95(3):180-2. [PMID] [PMCID]
[8] Rubin MR, Bilezikian JP. Hypoparathyroidism: Clinical features, skeletal microstructure and parathyroid hormone replacement. Arquivos Brasileiros de Endocrinologia & Metabologia. 2010; 54(2):220-6. [DOI:10.1590/S0004-27302010000200019] [PMID] [PMCID]
[9] Verma I, Gupta R, Singh S, Warkade D, Subhash N, Bose CH. Bilateral symmetrical basal ganglia calcification with atypical presentation: A case series. 2016. https://www.semanticscholar.org/paper/ Bilateral-Symmetrical-Basal-Ganglia-Calcification-A-Verma-Gupta/ 0b1d8f05221aeff42c470f42a0148fbd8e5c5db5
[10] Moushumi L, Rajarshi M. Primary hypoparathyroidism misdiagnosed as epilepsy - a case report: Seizures, hypocalcemia and cerebral calcification. The Journal of the International Federation of Clinical Chemistry and Laboratory Medicine. 2014; 25(2):195-8. [PMID] [PMCID]
[11] Verulashvili IV, Glonti LSh, Miminoshvili DK, Maniia MN, Mdivani KS. Basal ganglia calcification: Clinical manifestations and diagnostic evaluation. Georgian Medical News. 2006; 140:39-43. [PMID]
[12] Basak RC. A case report of basal ganglia calcification: A rare finding of hypoparathyroidism. Oman Medical Journal. 2009; 24(3):220-2. [DOI:10.5001/omj.2009.44] [PMID] [PMCID]
[13] Koller WC, Cochran JW, Klawans HL. Calcification of the basal ganglia: Computerized tomography and clinical correlation. Neurology. 1979; 29(3):328-33. [DOI:10.1212/WNL.29.3.328] [PMID]
[14] Ehsaei MR, Abouei Mehrizi MA, Firouz F. Extensive intracranial calcification in a case of hypoparathyroidism: Case report. Iranian Journal of Neurosurgery. 2017; 2(4):22-4. [DOI:10.29252/irjns.2.4.22]
[15] Sabau M, Comanescu A, Maghiar T, Dinulescu D. Hypoparathyroidism diagnosed by neurological signs and widespread intracerebral calcifications. Romanian Journal of Neurology. 2010; 9(1):44-50. [DOI:10.37897/RJN.2010.1.8]
| Files | ||
| Issue | Vol 6 No 2 (2021): March-April | |
| Section | Case Report(s) | |
| DOI | https://doi.org/10.18502/crcp.v6i2.6684 | |
| Keywords | ||
| Hypoparathyroidism Intracranial calcification Generalized tonicclonic seizure | ||
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How to Cite
1.
Karimi Fard M, kafi M. Extensive Intracranial Calcification in aCase of Hypoparathyroidism Which Presented With Generalized Tonic-Clonic Seizure: A Case Report. CRCP. 2021;6(2):66-69.
