Parkinsonism and epilepsy as clinical manifestations of bilateral cerebral calcinosis. Case report

Abstract

Basal ganglia calcifications are a radiological finding in approximately 20 % of the general population and can be present in a variety of medical conditions. When they appear simultaneously, involving structures such as the globus pallidus, putamen, dentate nucleus of the cerebellum, and hemispheric white matter, they are pathological and have a wide spectrum of clinical manifestations. The case presented is a 69-year-old female patient who underwent thyroidectomy due to a tumor approximately 15 years ago, with postoperative hypothyroidism and hypoparathyroidism. She presented with motor clumsiness, tremor; epileptic seizures with sudden loss of consciousness and generalized tonic-clonic movements, irritability, anxiety, depression, impaired recent memory, and sleep disturbances. Physical examination revealed symmetrical parkinsonism associated with late-onset epilepsy and a possible structural etiology. Based on the patient's history, neuropsychiatric manifestations, and the CT scan demonstrating bilateral cerebral calcinosis, the patient was diagnosed with Fahr syndrome secondary to postsurgical hypoparathyroidism. This case is of interest because it constitutes a rare nosological entity, and is reported with the objective of characterizing parkinsonism and epilepsy as clinical manifestations of these calcifications. A diagnosis of parkinsonism with symmetrical presentation of cardinal motor signs, postural and action tremor, late-onset epilepsy, and psychiatric manifestations raises suspicion of a possible structural lesion, such as bilateral cerebral calcinosis. Determining whether it is this disease or Fahr syndromes, and identifying the etiology in the latter, are of therapeutic and prognostic importance.