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Haider A, Liang X, Khan M. Fahr’s Syndrome in the Setting of Abnormal Calcium-Phosphate Metabolism and Lupus Nephritis. Cureus 2022; 14:e22298. [PMID: 35350516 PMCID: PMC8933265 DOI: 10.7759/cureus.22298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2022] [Indexed: 11/16/2022] Open
Abstract
Fahr’s syndrome is a rare neurodegenerative disorder characterized by bilateral calcifications of the basal ganglia and cerebral cortex. These deposits are made of calcium and phosphorus and are thought to be due to abnormalities in calcium-phosphate homeostasis. The clinical manifestation includes extrapyramidal symptoms (e.g., spastic paralysis), generalized or partial seizures, cognitive impairment, and neuropsychiatric symptoms. Here, we discuss a case of a young female with a medical history of systemic lupus erythematosus (SLE) and lupus nephritis who developed generalized seizures and was found to have extensive bilateral calcifications in the basal ganglia and cerebral cortex. Her laboratory workup showed disorganized calcium-phosphorus homeostasis.
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G J, Bansal R, Ajmal M, Gupta P, Pathania M. Young Male With Seizure Disorder and Intracranial Calcification: A Case of Fahr’s Syndrome. Cureus 2022; 14:e22189. [PMID: 35308708 PMCID: PMC8925936 DOI: 10.7759/cureus.22189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2022] [Indexed: 11/18/2022] Open
Abstract
Fahr’s syndrome is a neurodegenerative disorder characterized by abnormal deposition of calcium in the brain, especially in basal ganglia. The term Fahr’s disease is used when primary familial brain calcification is present, and the term Fahr’s syndrome is used for secondary causes. Our patient is a 35-year-old male who presented to our hospital with complaints of two episodes of generalized tonic-clonic seizures. He had a history of recurrent episodes of seizures since the age of 15 and they all were generalized tonic-clonic seizures. He did not have a family history of epilepsy. Lab investigations showed a normal hemogram, and liver and renal function were within normal limits. Serum electrolyte levels showed hypocalcemia, but other electrolyte levels were normal. He had low parathyroid hormone levels and normal levels of vitamin D. Brain imaging studies with non-contrast CT and a contrast-enhanced MRI showed bilaterally symmetrical dense calcifications. The etiology in our patient was the primary hypoparathyroidism and was treated accordingly. He reported symptomatic improvement with treatment and had no episodes of seizures after the commencement of the treatment. So, in cases of Fahr’s syndrome, treatable etiologies must be ruled out as they can delay the progression of the disease.
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53
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Bhat V, Goutham MK, Varghese S, Aroor R, Kumar Bhandary BS. A rare case of Fahr's syndrome with bilateral vocal cord palsy. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_106_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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54
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de Arruda ACG, Guerra ACDZ, Pessoa CH, Marquezine GF, Delfino VDA. Hypoparathyroidism and Fahr's syndrome: case series. J Bras Nefrol 2022; 44:592-596. [PMID: 34224552 PMCID: PMC9838678 DOI: 10.1590/2175-8239-jbn-2020-0243] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 03/06/2021] [Indexed: 01/26/2023] Open
Abstract
Hypoparathyroidism (HP) is a rare metabolic disorder and causes hypocalcemia because parathyroid hormone secretion is inadequate to mobilize calcium from bone and reabsorb calcium from kidney and gut. Anterior neck surgery is the most common cause of acquired HP and autoimmune HP is the next most common form in adults. The duration, severity, and rate of development of hypocalcemia determine the clinical presentation. A variety of organs can be affected by calcification, more frequently kidneys, but also joints, eyes, skin, vasculature, and other organ systems and, although rarely seen, intracerebral calcifications. We report four cases of bilateral basal ganglia calcifications (BGC) also known as Fahr's syndrome related to hypoparathyroidism. Fahr's syndrome is characterized by bilateral symmetrical calcification of areas of the brain that control movements including basal ganglia, thalamus, and others; it is a rare inherited or sporadic neurological disorder with a prevalence of less than 1/1.000.000. Main symptoms related to bilateral BGC include extra-pyramidal and cerebellar disorders, cognitive impairment, epileptic seizures, and psychiatric changes. BGC has been established as a possible outcome of HP. Its prevalence, demonstrated in the HP cohorts, varied significantly from 12 up to 74%. Currently, computed tomography (CT) is the most valuable method for diagnosis. The treatment include symptomatic support and identification of causes, but there is no specific treatment limiting the progression of calcification in the basal ganglia. Especially in HP, an early treatment can prevent calcification and neurophysiological disorders.
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55
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Chhetri B, Gyeltshen D, Letho Z. Bipolar affective disorder in a patient with Fahr’s disease: The first recorded case in Bhutan. SAGE Open Med Case Rep 2022; 10:2050313X221125324. [PMID: 36147593 PMCID: PMC9486261 DOI: 10.1177/2050313x221125324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 08/24/2022] [Indexed: 11/15/2022] Open
Abstract
Fahr’s disease is a rare neurological disease that typically presents with neurological manifestations such as movement disorders. In a first recorded patient with Fahr’s disease in Bhutan, psychiatric diagnosis of bipolar affective disorder with current episode of severe depression was made, which is also a known manifestation of Fahr’s disease. Diagnosing a first case of Fahr’s disease is important for Bhutan because, though, it is a rare disease and it emphasizes the importance of recognizing other rare causes of psychiatric illness to tailor the treatment to the individual.
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Affiliation(s)
- Bikram Chhetri
- Department of Psychiatry, Jigme Dorji Wangchuck National Referral, Thimphu, Bhutan
| | - Dawa Gyeltshen
- Department of Medicine, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
| | - Zimba Letho
- Medical Education and Research Unit, Jigme Dorji Wangchuck National Referral Hospital, Thimphu, Bhutan
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56
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Abhilasha P, Vimalanathane M, Prasad A. A case of schizophrenia-like psychosis due to Fahr's disease. ARCHIVES OF MENTAL HEALTH 2022. [DOI: 10.4103/amh.amh_33_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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57
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Ghogare AS, Nemade S. Fahr’s Syndrome Presenting As Pre-senile Dementia With Behavioral Abnormalities: A Rare Case Report. Cureus 2021; 13:e20680. [PMID: 35106221 PMCID: PMC8786577 DOI: 10.7759/cureus.20680] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2021] [Indexed: 11/05/2022] Open
Abstract
Fahr’s syndrome is a rare neurological disorder characterized by bilateral basal ganglia calcification. Calcification may also involve other brain areas like dentate nuclei of the cerebellum, thalamus, cerebral cortex, hippocampus, and subcortical white matter. Many cases of Fahr’s syndrome present with movement disorders, but may also present with dementia, psychiatric manifestations, and language difficulties. Fahr’s syndrome generally occurs secondary to metabolic abnormality mainly hypoparathyroidism. Fahr’s disease is another variant that is characterized by idiopathic bilateral calcification of basal ganglia in absence of any evident etiology. The present case report presented a rare case of Fahr’s syndrome secondary to hypoparathyroidism presenting with pre-senile dementia with behavioral abnormalities.
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58
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Lin J, Hou Y, Shang H. Clinical Reasoning: A Middle-aged Man With Progressive Gait Abnormalities. Neurology 2021; 97:e2423-e2428. [PMID: 34504025 DOI: 10.1212/wnl.0000000000012756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Progressive spastic paraplegia is the core symptom of hereditary spastic paraplegias (HSPs), a group of monogenic disorders characterized pathologically by degeneration of the corticospinal tract and dorsal column and leading to irreversible neurologic deficits. However, acquired causes, such as structural, vascular, inflammatory, infectious, metabolic, toxic, neurodegenerative, and iatrogenic causes, can also cause acquired spastic paraplegia. We describe the case of a middle-aged man presenting with progressive spastic paraplegia combined with ataxia and parkinsonism. No mutation of HSP genes was detected. After a comprehensive diagnostic workup, hyperintensities in the bilateral basal ganglia, mesencephalon, pons, and cerebellum on T1-weighted images were found, which demonstrated hypointensity on susceptibility-weighted imaging. Furthermore, an increased blood ammonia level and diffuse slow-wave activity in EEG were detected. The patient had a 7-year history of hypertension, alcoholic liver cirrhosis, and transjugular intrahepatic portosystemic shunt operation 2 years before the onset of spastic paraplegia symptoms. Current workup combined with patient history resulted in a diagnosis of acquired hepatocerebral degeneration and hepatic myelopathy.. This case provided a detailed diagnostic approach for progressive spastic paraplegias and exhaustive differential diagnoses of basal ganglia deposits. The take-home message from this case was that acquired causes, especially curable causes, should always be excluded first when dealing with patients with progressive spastic paraplegia.
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Affiliation(s)
- Junyu Lin
- From the Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Yanbing Hou
- From the Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Huifang Shang
- From the Department of Neurology, West China Hospital, Sichuan University, Chengdu, China.
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59
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Bogler O, Shumak SL. Diffuse intracranial calcifications in a patient with untreated postoperative hypoparathyroidism. CMAJ 2021; 193:E1890. [PMID: 34903593 PMCID: PMC8677579 DOI: 10.1503/cmaj.210940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- Orly Bogler
- Department of Medicine, University of Toronto, Toronto, Ont.
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60
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Aldawsari FM, Alotaibi TB, Hashim OS, Bu Hamad ZA, Eisaa MR, Alhumaidi AA, Alanazi SM, Alenezi FF, Batwie AA, Habib AA, Alismail SS, Almulhim OS, Al Amer AF, Alghamdi TA, Al-Hawaj F. Fahr Disease: A Rare Cause of First-Time Seizure in the Emergency Department. Cureus 2021; 13:e19965. [PMID: 34984125 PMCID: PMC8713734 DOI: 10.7759/cureus.19965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2021] [Indexed: 11/22/2022] Open
Abstract
Seizure is a common neurological problem in the emergency department. First-time seizure needs careful evaluation to exclude the underlying structural brain lesions. Neuroimaging studies, including magnetic resonance imaging and computed tomography scan, are strongly recommended for all adult patients with first-time seizures. We report the case of a 35-year-old woman who was brought to the emergency department because of the first-time loss of consciousness episode. She developed bilateral jerky movements in both her upper and lower limbs. It was associated with frothy secretions from the mouth and cyanosis. The episode lasted for two minutes and terminated spontaneously. The patient was tired after gaining consciousness. The past medical history of the patient was remarkable for anxiety, depression, and polycystic ovarian syndrome. She has undergone multiple cognitive behavioral therapy sessions, but she did not take any psychiatric medications. Neurological examination did not reveal any focal neurological deficit. The patient underwent a computed tomography scan to exclude any space-occupying lesion. The unenhanced scan demonstrated bilateral symmetrical calcification of the basal ganglia. No calcification was noted in the cerebellum or the cerebral cortex. Otherwise, no intracranial pathology was seen. Such findings conferred the diagnosis of Fahr disease. The patient was discharged on carbamazepine to prevent further seizure episodes. After six months of follow-up, the patient did not experience further convulsion episodes. Fahr disease is a rare disorder with a wide spectrum of manifestations. Despite its rarity, physicians should keep this condition as a possible differential diagnosis when they encounter an adult patient with a first-time seizure, particularly in a patient with a history of neuropsychiatric disorders.
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Affiliation(s)
| | | | - Omran S Hashim
- National Guard Health Affairs, Prince Mohammed Bin Abdulaziz Hospital, Medina, SAU
| | | | - Maha R Eisaa
- Medicine, Sulaiman Al Rajhi University, Qassim, SAU
| | | | | | - Fahad F Alenezi
- Medicine, Jordan University of Science and Technology, Irbid, JOR
| | | | | | | | | | | | | | - Faisal Al-Hawaj
- Medicine, Imam Abdulrahman Bin Faisal University, Dammam, SAU
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61
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Okrzeja J, Narejko K, Tarasów E, Zajkowska J, Garkowski A. Fahr syndrome - an incidental finding in a patient with lymphocytic meningitis. Radiol Case Rep 2021; 16:3855-3858. [PMID: 34691349 PMCID: PMC8517281 DOI: 10.1016/j.radcr.2021.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 09/14/2021] [Accepted: 09/16/2021] [Indexed: 11/29/2022] Open
Abstract
Fahr syndrome is a rare condition mainly characterized by symmetric and bilateral calcification of basal ganglia and cerebellar nuclei. Herein, we report a case of a 67-year-old woman with a history of parathyroidectomy and Parkinsonism, who was admitted to hospital with suspected neuroinfection, and imaging features that were consistent with Fahr syndrome. The objective of this study is to teach clinicians about a neurologic illness that requires comprehensive medical and neurologic investigation due to the manifestations of lymphocytic meningitis might distract you from Fahr syndrome symptoms.
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Affiliation(s)
- Jakub Okrzeja
- Medical University of Białystok, Białystok, Poland
- Corresponding author. https://www.umb.edu.pl/wl/sp-lom
| | | | - Eugeniusz Tarasów
- Department of Radiology, Medical University of Białystok, Białystok, Poland
| | - Joanna Zajkowska
- Department of Infectious Diseases and Neuroinfections, Medical University of Białystok, Białystok, Poland
| | - Adam Garkowski
- Independent Department, Laboratory of Molecular Imaging, Medical University of Białystok, Białystok, Poland
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62
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Singh R, Sahu A, Singh RC, Bhaikhel KS, Prasad RS. Clinical and Outcome Analysis in Head Injury Patients with Fahr's Disease. Asian J Neurosurg 2021; 16:549-553. [PMID: 34660367 PMCID: PMC8477836 DOI: 10.4103/ajns.ajns_92_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 04/09/2021] [Accepted: 05/30/2021] [Indexed: 11/28/2022] Open
Abstract
Context: Fahr's disease (FD) is a rare neurodegenerative disorder. Head injury in patients with FD is an uncommon occurrence. Aim: The aim is to evaluate clinical and outcome characteristics in traumatic head injury patients with FD. Settings and Design: Retrospective cohort study. Materials and Methods: This retrospective cohort study includes 13 patients of FD presenting as head injury in neurosurgical emergency between September 2018 and February 2021. Each patient was evaluated in terms of demographic profile, Glasgow coma scale (GCS) at admission, severity of head injury, type of head injury, preexisting clinical features of FD, radiological findings, Glasgow outcome score (GOS), family history of FD, and biochemical abnormalities. Patients were also evaluated for dichotomized outcome (Good recovery: GOS 5–4 versus Poor recovery: GOS 1–3) and gender differences in FD presentation. Statistical Analysis Used: Fisher's exact test and unpaired t-test were used. P < 0.05 was considered statistically significant. Results: Neurological symptoms (69.2%), neuropsychiatric manifestations (46.1%) and extrapyramidal features (38.5%) were preexisting in these patients. Seizure (61.5%) was the most common neurological manifestation. Depression (23.1%) and anxiety disorder (15.4%) were common psychiatric disorders seen. Akathisia (23.1%) followed by tremor (15.4%) were predominant extrapyramidal presentations. On dichotomized outcome analysis, preexisting neurological, neuropsychiatric, and extrapyramidal manifestations due to FD were not associated significantly with outcome following head injury. GCS at admission, severity of head injury and pupillary changes were significantly associated with outcome (P < 0.05). Neuropsychiatric features (P = 0.0210) were significantly more in females suffering from FD. Conclusions: Neurological features in FD predominate over neuropsychiatric and extrapyramidal symptoms. FD does not affect outcome following head injury.
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Affiliation(s)
- Rahul Singh
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Anurag Sahu
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ramit Chandra Singh
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Kulwant Singh Bhaikhel
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Ravi Shankar Prasad
- Department of Neurosurgery, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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63
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Salamon A, Zádori D, Ujfalusi A, Szpisjak L, Lukács M, Bihari B, Szépfalusi N, Németh VL, Maróti Z, Horváth E, Balogh I, Bereczki C, Klivényi P, Kalmár T. Hereditary and non-hereditary etiologies associated with extensive brain calcification: case series. Metab Brain Dis 2021; 36:2131-2139. [PMID: 34287746 DOI: 10.1007/s11011-021-00790-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 07/01/2021] [Indexed: 10/20/2022]
Abstract
Cerebral calcification may be caused by several potentially treatable conditions, however, in most cases it does not receive special attention in clinical practice. From the point of view of etiology, the diseases associated with cerebral calcification can be divided into two main groups: idiopathic (mostly incurable) and secondary (potentially treatable). The first group includes mainly the hereditary diseases identified before 2021 (primary familial brain calcification subtypes, previously known as Fahr's disease or Fahr's syndrome). In contrast, the second group includes diseases with cerebral calcification that develop generally as a consequence of metabolic/endocrine/autoimmune abnormalities. The aim of our research was to present hereditary and non-hereditary etiologies associated with extensive brain calcification. We compare the detailed clinical, radiological and laboratory results of 6 patients with prominent cerebral calcification identified in our clinic in the last 3 years (idiopathic and secondary etiologies as well). Our research draws attention to the complexity of the etiologies in the context of cerebral calcification. We recommend, beside NGS-based sequence analyses, the application of array comparative genomic hybridization as well, to identify potential genetic etiologies associated with brain calcification.
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Affiliation(s)
- András Salamon
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Dénes Zádori
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Anikó Ujfalusi
- Division of Clinical Genetics, Department of Laboratory of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - László Szpisjak
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Melinda Lukács
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | | | - Noémi Szépfalusi
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Viola Luca Németh
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Zoltán Maróti
- Department of Pediatrics, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Korányi fasor 14-15, Szeged, H-6725, Hungary
| | - Emese Horváth
- Department of Medical Genetics, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - István Balogh
- Division of Clinical Genetics, Department of Laboratory of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Csaba Bereczki
- Department of Pediatrics, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Korányi fasor 14-15, Szeged, H-6725, Hungary
| | - Péter Klivényi
- Department of Neurology, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Szeged, Hungary
| | - Tibor Kalmár
- Department of Pediatrics, Faculty of Medicine, Albert Szent-Györgyi Clinical Center, University of Szeged, Korányi fasor 14-15, Szeged, H-6725, Hungary.
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64
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Mohammedin AS, Alkharashi AF, Alabdulqader AA, Abualola HA, Serih MA. Fahr's Syndrome Presenting With Hypocalcemia and Psychotic Features. Cureus 2021; 13:e18091. [PMID: 34557375 PMCID: PMC8449926 DOI: 10.7759/cureus.18091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/05/2022] Open
Abstract
Fahr's disease is a rare genetic neurodegenerative disorder described as “bilateral striopallidodentate calcinosis” (BSPDC). It is characterized by calcium deposition crossing the blood-brain barrier and calcifying different brain areas. Here, we report a case of a 26-year-old Saudi young lady, known as a case of epilepsy since childhood, a major depressive disorder with psychotic features, and hypocalcemia related to hypoparathyroidism. CT brain showed extensive coarse calcifications involving the infra and supratentorial white matter, predominantly within the basal ganglia, thalami, and dentate nuclei of cerebellar hemispheres. This report will discuss the challenging presentation, clinical symptoms, and the multidisciplinary approach to manage Fahr's syndrome symptoms. In conclusion, this case emphasizes the importance of neuroimaging and metabolic workup when investigating the seizure's etiology. The goal of treatment in Fahr's syndrome is to manage the underlying conditions.
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Affiliation(s)
- Ahmed S Mohammedin
- Geriatric Medicine, Ain Shams University, Cairo, EGY.,Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Abdullah F Alkharashi
- Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Azzam A Alabdulqader
- Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Hossain A Abualola
- Radiology, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
| | - Mohammed A Serih
- Geriatric Medicine, Ain Shams University, Cairo, EGY.,Internal Medicine - Geriatrics, King Fahad Hospital of the University, Imam Abdulrahman Bin Faisal University, Khobar, SAU
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65
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Iwase T, Yoshida M, Iwasaki Y, Suzuki S, Yabata H, Koizumi R, Moriyoshi H, Yazawa I. Selective extension of cerebral vascular calcification in an autopsy case of Fahr's syndrome associated with asymptomatic hypoparathyroidism. Neuropathology 2021; 41:387-395. [PMID: 34462978 DOI: 10.1111/neup.12760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 04/29/2021] [Accepted: 05/09/2021] [Indexed: 11/30/2022]
Abstract
We report an autopsy case of Fahr's syndrome in an 85-year-old woman associated with asymptomatic hypoparathyroidism. The patient was diagnosed as having brain calcification at 65 years of age. She developed mild dementia at 75, parkinsonism at 76, and severe dementia at 82. Computed tomography revealed extensive, symmetric intracranial calcification, involving both sides of the basal ganglia and cerebellar dentate nuclei, and severe cerebral atrophy that developed afterwards. A neuropathological examination revealed intracranial calcification, particularly in the wall of the arterioles and capillaries having numerous calcium deposits. Severe vascular calcification and severe neuronal loss without α-synuclein accumulation were found in the substantia nigra. There were high-level neuropathological changes indicative of Alzheimer's disease. Although the colocalization of calcium and amyloid-β deposits in the same arterial wall was rare, both of them were located in a similar layer of the arterial wall. The vascular calcification in the basal ganglia spread continuously through the corona radiata into the selective cerebral areas along the medullary arteries, but did not involve the corpus callosum or insular region. Stone formation was observed at the corona radiata adjacent to the superolateral angles of the lateral ventricles. We hypothesized that there would be a stereotypical extension pattern of vascular calcification related to the arrangement of penetrating arteries in Fahr's syndrome.
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Affiliation(s)
- Tamaki Iwase
- Department of Neurology, Nagoya City Koseiin Medical Welfare Center, Aichi, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan
| | - Yasushi Iwasaki
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan
| | - Shugo Suzuki
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan.,Department of Molecular Pathology, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Hiroyuki Yabata
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan.,Department of Neurology, Shiga University of Medical Science, Shiga, Japan
| | - Ryuichi Koizumi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan.,Department of Neurology and Stroke Medicine, Yokohama City University School of Medicine Graduate School of Medicine, Kanagawa, Japan
| | - Hideyuki Moriyoshi
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Ikuru Yazawa
- Faculty of Health and Medical Sciences, Department of Occupational Therapy, Tokoha University, Shizuoka, Japan
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66
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Rashid Khan Z, Waheed W, Mabood J, Ali A, Burki G. A Unique Presentation of Fahr's Syndrome Secondary to Hypoparathyroidism. Cureus 2021; 13:e16063. [PMID: 34345548 PMCID: PMC8323617 DOI: 10.7759/cureus.16063] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/30/2021] [Indexed: 12/25/2022] Open
Abstract
Fahr's syndrome is a rare condition characterized by deposition of bilateral symmetric calcium deposits in the basal ganglia and cerebellar region, leading to neurological and psychiatric sequelae. Herein we describe a case of a 62-year-old female presented with aphasia, bilateral lower limb rigidity, tremors, and gait disturbance. Her past medical history included thyroidectomy and radiation therapy 10 years back due to papillary carcinoma of the thyroid gland. On examination, she had poor speech, resting tremor, walking difficulty, and decreased power in all limbs with rigidity. Her Chvostek and Trousseau signs were positive. Serum investigations revealed hypocalcemia and low levels of parathyroid hormone and thyroid-stimulating hormone. Brain magnetic resonance imaging revealed calcified lesions in basal ganglia, thalami, and dentate nuclei. She was diagnosed with Fahr's syndrome due to hypoparathyroidism, and she was managed with calcium gluconate, vitamin D, salt-free albumin, and levodopa-carbidopa, improving her condition. The patient was then discharged on calcium gluconate, calcitriol, recombinant parathyroid hormone, and levodopa-carbidopa with follow-up.
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Affiliation(s)
- Zaraq Rashid Khan
- Internal Medicine, Hayatabad Medical Complex Peshawar, Peshawar, PAK
| | - Waqar Waheed
- Internal Medicine, Mufti Mehmood Memorial Teaching Hospital, Dera Ismail Khan, PAK
| | - Jawad Mabood
- Internal Medicine, Khyber Medical University, Peshawar, PAK
| | - Asim Ali
- Internal Medicine, Hayatabal Medical Complex, Peshawar, PAK
| | - Gulalai Burki
- Gyanecology, Khyber Medical University, Peshawar, PAK
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Clinicopathological co-occurrence of Fahr's disease and dementia with Lewy bodies. Clin Neuropathol 2021; 39:227-231. [PMID: 32145757 DOI: 10.5414/np301267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2020] [Indexed: 11/18/2022] Open
Abstract
We present the clinicopathological findings of a case of combined Fahr's disease (FD) and dementia with Lewy bodies (DLB), associated with a novel pathogenic mutation. The patient presented with visual hallucinations, fluctuating confusion and parkinsonism, leading to a presumptive diagnosis of DLB. CT scan showed extensive bilateral parenchymal calcifications, suggestive of FD. DNA sequencing identified a novel missense variant (c.92A>T p.(Asn31Ile)) in the SLC20A2 gene, a gene known to be associated with FD. This change has not been previously recorded in genetic repositories, and in silico analyses classified it as likely to be disease-causing. The patient died aged 77, four years after symptom onset. Neuropathological examination revealed, macroscopically and microscopically, extensive calcification in the striatum, globus and cerebellar white matter. There was also neuronal loss in the substantia nigra and residual neurones contained alpha-synuclein-positive Lewy bodies. The neuropathology was therefore consistent with DLB and FD. A literature review identified 3 other cases of co-existing Fahr's and Lewy body pathology, thus the frequency of dual pathology (44%) is higher than expected by random association. Further studies are needed to determine whether alpha-synucleinopathy is linked mechanistically to FD and/or represents a phenotypic subtype.
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Smith P, Ng K, Krishnan K. Fahr's disease with an initial presentation of crescendo TIA. BMJ Case Rep 2021; 14:14/6/e242837. [PMID: 34187801 DOI: 10.1136/bcr-2021-242837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 51-year-old man presented with vertigo, slurred speech and left facial droop. He had been previously diagnosed with transient ischaemic attack (TIA) and had a prior lacunar infarct. Imaging showed heavy symmetrical calcification in the globus pallidus, frontal white matter and cerebellar dentate nuclei/deep white matter. The imaging was pathognomonic for Fahr's disease and diagnosis was confirmed when other secondary causes of hypercalcemia were excluded. Fahr's disease is a rare, autosomal dominant, neurological condition characterised by primary brain calcification. Patients present with progressive neurological and psychiatric symptoms; commonly, Parkinsonian movement disorders, seizures, headaches, dysarthria, cognitive decline, psychosis and personality changes. There is an association with intracerebral ischaemic events. This case supports a growing body of anecdotal evidence of this association and is the first in which crescendo TIA may be the initial presentation of Fahr's disease. Referral for genetic counselling and symptomatic relief for neurological symptoms are the main management strategies.
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Affiliation(s)
- Paul Smith
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kalun Ng
- Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Kailash Krishnan
- Stroke Medicine, Nottingham University Hospitals NHS Trust, Nottingham, UK
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Pereira GS, Ferreira A, Castro L, Fernandes M, Cotter J. From cranial nerve palsy to seizures-All the signs that lead to secondary Fahr's syndrome. Clin Case Rep 2021; 9:e03669. [PMID: 34084472 PMCID: PMC8142300 DOI: 10.1002/ccr3.3669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 12/04/2020] [Indexed: 11/25/2022] Open
Abstract
Neuroimaging scan and calcium/phosphorus metabolism evaluation should be considered in patients with new onset of neuropsychiatric symptoms, to provide an earliest detection of pathological and metabolic alterations, such as Fahr's syndrome.
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Affiliation(s)
| | - Ana Ferreira
- Internal MedicineHospital Senhora da OliveiraGuimarãesPortugal
| | - Laura Castro
- Internal MedicineHospital Senhora da OliveiraGuimarãesPortugal
| | - Magda Fernandes
- Internal MedicineHospital Senhora da OliveiraGuimarãesPortugal
| | - Jorge Cotter
- Internal MedicineHospital Senhora da OliveiraGuimarãesPortugal
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Ren Y, Shen Y, Si N, Fan S, Zhang Y, Xu W, Shi L, Zhang X. Slc20a2-Deficient Mice Exhibit Multisystem Abnormalities and Impaired Spatial Learning Memory and Sensorimotor Gating but Normal Motor Coordination Abilities. Front Genet 2021; 12:639935. [PMID: 33889180 PMCID: PMC8056086 DOI: 10.3389/fgene.2021.639935] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/03/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Primary familial brain calcification (PFBC, OMIM#213600), also known as Fahr's disease, is a rare autosomal dominant or recessive neurodegenerative disorder characterized by bilateral and symmetrical microvascular calcifications affecting multiple brain regions, particularly the basal ganglia (globus pallidus, caudate nucleus, and putamen) and thalamus. The most common clinical manifestations include cognitive impairment, neuropsychiatric signs, and movement disorders. Loss-of-function mutations in SLC20A2 are the major genetic causes of PFBC. OBJECTIVE This study aimed to investigate whether Slc20a2 knockout mice could recapitulate the dynamic processes and patterns of brain calcification and neurological symptoms in patients with PFBC. We comprehensively evaluated brain calcifications and PFBC-related behavioral abnormalities in Slc20a2-deficient mice. METHODS Brain calcifications were analyzed using classic calcium-phosphate staining methods. The Morris water maze, Y-maze, and fear conditioning paradigms were used to evaluate long-term spatial learning memory, working memory, and episodic memory, respectively. Sensorimotor gating was mainly assessed using the prepulse inhibition of the startle reflex program. Spontaneous locomotor activity and motor coordination abilities were evaluated using the spontaneous activity chamber, cylinder test, accelerating rotor-rod, and narrowing balance beam tests. RESULTS Slc20a2 homozygous knockout (Slc20a2-HO) mice showed congenital and global developmental delay, lean body mass, skeletal malformation, and a high proportion of unilateral or bilateral eye defects. Brain calcifications were detected in the hypothalamus, ventral thalamus, and midbrain early at postnatal day 80 in Slc20a2-HO mice, but were seldom found in Slc20a2 heterozygous knockout (Slc20a2-HE) mice, even at extremely old age. Slc20a2-HO mice exhibited spatial learning memory impairments and sensorimotor gating deficits while exhibiting normal working and episodic memories. The general locomotor activity, motor balance, and coordination abilities were not statistically different between Slc20a2-HO and wild-type mice after adjusting for body weight, which was a major confounding factor in our motor function evaluations. CONCLUSION The human PFBC-related phenotypes were highly similar to those in Slc20a2-HO mice. Therefore, Slc20a2-HO mice might be suitable for the future evaluation of neuropharmacological intervention strategies targeting cognitive and neuropsychiatric impairments.
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Affiliation(s)
- Yaqiong Ren
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yuqi Shen
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Nuo Si
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Shiqi Fan
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yi Zhang
- National Health Commission and Chinese Academy of Medical Sciences Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China
| | - Wanhai Xu
- National Health Commission and Chinese Academy of Medical Sciences Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China
| | - Lei Shi
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- National Health Commission and Chinese Academy of Medical Sciences Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China
| | - Xue Zhang
- McKusick-Zhang Center for Genetic Medicine, State Key Laboratory of Medical Molecular Biology, Institute of Basic Medical Sciences, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
- National Health Commission and Chinese Academy of Medical Sciences Key Laboratory of Molecular Probe and Targeted Theranostics, Harbin Medical University, Harbin, China
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Beneki E, Papazarkadas X, Karras A, Kalantzis K, Tsatiris K. A Rare Case of Fahr's Syndrome in a Patient with Secondary Hypoparathyroidism and Neuropsychiatric Symptoms. INNOVATIONS IN CLINICAL NEUROSCIENCE 2021; 18:11-14. [PMID: 34980977 PMCID: PMC8667711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Fahr's syndrome, also known as basal ganglia calcification, is a rare neurodegenerative disorder characterized by radiological findings of symmetrical and bilateral idiopathic abnormal deposits of calcium in areas of the brain that control motor activity, including the basal ganglia and the cerebral cortex. There is neither a specific cure, nor a standard treatment for Fahr's syndrome and treatment is primarily symptomatic. Brain imaging has gained widespread use in order to support clinicians in diagnosing intracranial calcifications. CASE PRESENTATION We present a case of an 83-year-old female patient who presented with symptoms of confusion, fever, nausea, and vomiting. Clinical diagnosis of Fahr's syndrome secondary to hypopathyroidism was based on the neuropsychiatric signs and symptoms, laboratory evidence of hypoparathyroidism, and radiological signs of calcifications in the basal ganglia. The patient improved following replacement therapy with calcium gluconate, followed by oral supplemental calcitriol. CONCLUSION This case highlights the importance of considering organic causes when patients present with neuropsychiatric disturbances, especially following thyroidectomy.
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Affiliation(s)
- Eirini Beneki
- Drs. Beneki and Tsatiris are with the Department of Cardiology at Karditsa General Hospital in Karditsa, Greece
- Dr. Papazarkadas is with the Department of General Surgery at the Hospital of Valais (CHVR) in Sion, Switzerland
- Drs. Karras and Kalantzis are with the Department of Internal Medine at Karditsa General Hospital in Karditsa, Greece
| | - Xenofon Papazarkadas
- Drs. Beneki and Tsatiris are with the Department of Cardiology at Karditsa General Hospital in Karditsa, Greece
- Dr. Papazarkadas is with the Department of General Surgery at the Hospital of Valais (CHVR) in Sion, Switzerland
- Drs. Karras and Kalantzis are with the Department of Internal Medine at Karditsa General Hospital in Karditsa, Greece
| | - Achillefs Karras
- Drs. Beneki and Tsatiris are with the Department of Cardiology at Karditsa General Hospital in Karditsa, Greece
- Dr. Papazarkadas is with the Department of General Surgery at the Hospital of Valais (CHVR) in Sion, Switzerland
- Drs. Karras and Kalantzis are with the Department of Internal Medine at Karditsa General Hospital in Karditsa, Greece
| | - Konstantinos Kalantzis
- Drs. Beneki and Tsatiris are with the Department of Cardiology at Karditsa General Hospital in Karditsa, Greece
- Dr. Papazarkadas is with the Department of General Surgery at the Hospital of Valais (CHVR) in Sion, Switzerland
- Drs. Karras and Kalantzis are with the Department of Internal Medine at Karditsa General Hospital in Karditsa, Greece
| | - Konstantinos Tsatiris
- Drs. Beneki and Tsatiris are with the Department of Cardiology at Karditsa General Hospital in Karditsa, Greece
- Dr. Papazarkadas is with the Department of General Surgery at the Hospital of Valais (CHVR) in Sion, Switzerland
- Drs. Karras and Kalantzis are with the Department of Internal Medine at Karditsa General Hospital in Karditsa, Greece
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Wang XT, Zhou L, Cai XY, Xu FX, Xu ZH, Li XY, Shen Y. Deletion of Mea6 in Cerebellar Granule Cells Impairs Synaptic Development and Motor Performance. Front Cell Dev Biol 2021; 8:627146. [PMID: 33718348 PMCID: PMC7946997 DOI: 10.3389/fcell.2020.627146] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Accepted: 12/21/2020] [Indexed: 01/04/2023] Open
Abstract
The cerebellum is conceptualized as a processor of complex movements. Many diseases with gene-targeted mutations, including Fahr's disease associated with the loss-of-function mutation of meningioma expressed antigen 6 (Mea6), exhibit cerebellar malformations, and abnormal motor behaviors. We previously reported that the defects in cerebellar development and motor performance of Nestin-Cre;Mea6 F/F mice are severer than those of Purkinje cell-targeted pCP2-Cre;Mea6 F/F mice, suggesting that Mea6 acts on other types of cerebellar cells. Hence, we investigated the function of Mea6 in cerebellar granule cells. We found that mutant mice with the specific deletion of Mea6 in granule cells displayed abnormal posture, balance, and motor learning, as indicated in footprint, head inclination, balanced beam, and rotarod tests. We further showed that Math1-Cre;Mea6 F/F mice exhibited disrupted migration of granule cell progenitors and damaged parallel fiber-Purkinje cell synapses, which may be related to impaired intracellular transport of vesicular glutamate transporter 1 and brain-derived neurotrophic factor. The present findings extend our previous work and may help to better understand the pathogenesis of Fahr's disease.
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Affiliation(s)
- Xin-Tai Wang
- Department of Physiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Lin Zhou
- Department of Physiology, School of Medicine, Zhejiang University, Hangzhou, China
- Department of Psychiatry, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Xin-Yu Cai
- Department of Physiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Fang-Xiao Xu
- Department of Physiology, School of Medicine, Zhejiang University, Hangzhou, China
| | - Zhi-Heng Xu
- State Key Laboratory of Molecular Developmental Biology, CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Genetics and Developmental Biology, Chinese Academy of Sciences, Beijing, China
| | - Xiang-Yao Li
- Department of Neurobiology, School of Brain Science and Brain Medicine, Zhejiang University, Hangzhou, China
| | - Ying Shen
- Department of Physiology, School of Medicine, Zhejiang University, Hangzhou, China
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73
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David K, Stinkens K, Decallonne B. Pseudohypoparathyroidism: a missed window of treatment opportunity? Acta Neurol Belg 2021; 121:259-260. [PMID: 31893352 DOI: 10.1007/s13760-019-01268-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 12/17/2019] [Indexed: 11/25/2022]
Affiliation(s)
- K David
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium.
| | - K Stinkens
- Department of Endocrinology, ZOL, Genk, Belgium
| | - B Decallonne
- Department of Endocrinology, University Hospitals Leuven, Leuven, Belgium
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Fahr's syndrome due to hypoparathyroidism revisited: A case of parkinsonism and a review of all published cases. Clin Neurol Neurosurg 2021; 202:106514. [PMID: 33529967 DOI: 10.1016/j.clineuro.2021.106514] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/18/2021] [Accepted: 01/19/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Fahr's syndrome due to hypoparathyroidism refers to bilateral basal ganglia (BG) calcifications and manifests with movement disorders, seizures, cognitive and behavioral symptoms. CASE PRESENTATION We report a case of a 74-year-old woman, who presented with parkinsonism due to post-surgical hypoparathyroidism and normal DaT scan, despite extensive calcifications of the BG, periventricular white matter, and cerebellum. METHODS A comprehensive literature review of all reported cases of Fahr's syndrome due to hypoparathyroidism was conducted in the electronic databases PubMed and Web of science. Moreover, demographic and clinical characteristics of the patients overall were calculated and associated with radiological findings. RESULTS We reviewed a total of 223 cases with Fahr's syndrome due to hypoparathyroidism (124 female, 99 male). Mean age on presentation was 44.6 ± 17.7 years. Thirty nine percent of patients had idiopathic hypoparathyroidism, 35.4 % acquired and 25.6 % pseudohypoparathyroidism. Almost half of the patients had tetany, seizures or a movement disorder and approximately 40 % neuropsychiatric symptoms. The patients with a movement disorder had a 2.23 likelihood of having neuropsychiatric symptoms as well (OR 2.23, 95 % CI 1.29-3.87). Moreover, there was a statistically significant association between the phenotype severity (i.e. the presence of more than one symptom) and the extent of brain calcifications (χ2 = 32.383, p = 0.009). CONCLUSION Fahr's syndrome is a rare disorder, which nonetheless manifests with several neurological symptoms. A head CT should be considered for patients with hypoparathyroidism and neurological symptoms. More studies using DaT scan are needed to elucidate the effects of calcifications on the dopaminergic function of the BG.
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75
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Amanam I, Mambetsariev I, Gupta R, Salgia R. Progressive Neurologic Changes in a Patient With Metastatic Non-Small-Cell Lung Cancer: Cancer Effects or a Secondary Diagnosis? JCO Oncol Pract 2021; 17:52-53. [PMID: 32644904 DOI: 10.1200/jop.19.00701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Idoroenyi Amanam
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA
| | - Isa Mambetsariev
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA
| | - Rohan Gupta
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA
| | - Ravi Salgia
- Department of Medical Oncology and Therapeutics Research, City of Hope National Medical Center, Duarte, CA
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The relation between tau pathology and granulovacuolar degeneration of neurons. Neurobiol Dis 2020; 147:105138. [PMID: 33069844 DOI: 10.1016/j.nbd.2020.105138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 10/05/2020] [Accepted: 10/09/2020] [Indexed: 12/30/2022] Open
Abstract
Neurofibrillary tangles arising from aggregated microtubule-associated protein tau occur in aged brains and are hallmarks of neurodegenerative diseases. A subset of neurons containing aggregated tau displays granulovacuolar degeneration (GVD) that is characterized by membrane-bound cytoplasmic vacuoles, each containing an electron-dense granule (GVB). Tau pathology induces GVBs in experimental models, but GVD does not generally follow tau pathology in the human brain. The entorhinal cortex, DRN, and LC are among the regions that display pathological changes of tau earliest, whereas neurons with GVBs occur first in the hippocampus and have been found in oral raphe nuclei only at the most advanced GVD stage. To date, there is no detailed report about neurons with GVD in aminergic nuclei. We studied the relation between tau pathology and GVD in field CA1 of the hippocampus, entorhinal cortex, dorsal (DRN) and median (MRN) raphe nucleus, and locus coeruleus from elderly subjects with Braak & Braak stages of tau pathology ranging from 0 to VI. Tau pathology and GVBs were visualized by means of immunolabeling and quantified. Percentages of neurons containing GVBs were significantly related to percentages of AT8-positive neurons in the regions examined. GVD and tau pathology were found together in neurons to a different extent in regions of the brain. 53.2% of AT8-immunoreactive neurons in CA1, 19.8% in layer II of the entorhinal cortex, 29.6% in the DRN, and 31.4% in the locus coeruleus contained GVBs. Age-related factors, the percentage of neurons with pretangles in a region of the brain, and the metabolism of a neuron possibly influence the prevalence of neurons with GVBs.
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77
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Fahr's syndrome presenting with seizures in SARS-CoV-2 (COVID-19) pneumonia-a case report. Neurol Sci 2020; 41:3063-3065. [PMID: 32965525 PMCID: PMC7509223 DOI: 10.1007/s10072-020-04733-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 09/15/2020] [Indexed: 11/01/2022]
Abstract
BACKGROUND Fahr's syndrome (or Fahr's disease) is a rare, neurological disorder characterized by bilateral calcification in the cerebellum, thalamus, basal ganglia, and cerebral cortex as a result of calcium and phosphorus metabolism disorder. The patients may be asymptomatic and clinical symptoms represent a wide range of neurologic manifestations and nonspecific neuropsychiatric disorders. We report an unusual case of Fahr's syndrome which was asymptomatic and incidentally diagnosed by generalized tonic-clonic seizure in a patient with SARS-CoV-2 (COVİD-19) pneumonia. CASE PRESENTATION The patient was a 68-year-old female and admitted to our emergency department suffering from cough and fatigue. After thorax computed tomography (CT) and SARS-CoV-2 PCR test, she was diagnosed as COVID-19 pneumonia. In the intensive care unit, the patient had a tonic-clonic convulsion starting from the left arm and spreading to the whole body. Fahr's syndrome was diagnosed after a cranial CT scan and blood metabolic panel test. CONCLUSIONS As a result of the clinical, radiological, and biochemical evaluations, the patient was diagnosed incidentally as Fahr's syndrome associated with hypoparathyroidism. Seizures could be induced by hydroxychloroquine that was in the COVID-19 treatment or the inflammation caused by COVID-19 pneumonia. The association between the mortality of COVID-19 pneumonia and Fahr's syndrome is unknown which needs further research.
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78
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Hurşıtoğlu O, Tuman TC. Fahr's Syndrome Misdiagnosed As Delusional Disorder: A Case Report. ACTA ACUST UNITED AC 2020; 57:254-256. [PMID: 32952430 DOI: 10.29399/npa.24888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 04/16/2020] [Indexed: 11/07/2022]
Abstract
Fahr's disease is a rare neurological disorder that is characterized by bilateral basal ganglia calcification. In the present study, a 49-year-old male patient presented with delusional beliefs. He had normal neurologic examination. Follow-up mental status examination and clinical findings revealed delusional disorder. After three weeks, the patient presented to the clinic with postural tremor in the hands, and gait difficulties. A cranial CT scan showed that he had bilateral basal ganglia, thalamus, and centrum semiovale calcifications. The case illustrates the importance of considering organic etiologies before diagnosing a patient, particularly one who has late-onset presentation of psychosis.
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Affiliation(s)
- Onur Hurşıtoğlu
- Necip Fazıl City Hospital, Department of Psychiatry, Kahramanmaraş, Turkey
| | - Taha Can Tuman
- Birecik State Hospital, Department of Psychiatry, Birecik, Şanlıurfa, Turkey
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Affiliation(s)
- Valerio Brunetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia; Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marco Luigetti
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia; Università Cattolica del Sacro Cuore, Rome, Italy
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Ozisik H, Yürekli BS, Tuncel R, Ozdemir N, Baklaci M, Ekmekci O, Saygili F. PSEUDOPSEUDOHYPOPARATHYROIDISM AS A CAUSE OF FAHR SYNDROME: HYPOPARATHYROIDISM NOT THE ONLY ONE. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:86-89. [PMID: 32685044 DOI: 10.4183/aeb.2020.86] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Introduction Fahr's syndrome is an infrequent disorder characterized by bilateral symmetrical calcification of basal ganglia and the cerebral cortex. It can be seen genetic, idiopathic, or secondary to endocrine diseases. This disease is related to different metabolic disorders particularly with diseases of the parathyroid gland. Case 1 A 63-year-old female patient applied to our clinic due to having hypoparathyroidism with bilateral basal ganglia calcification in head computed tomography(CT). She had subtotal thyroidectomy 25 years ago. In the neurological examination, mild symmetrical parkinsonism was determined. In laboratory examination Ca:8 mg/dL (8.6-10.2), P:5.1 mg/dL (2.3-4.5), PTH:9.53 pg/mL (15-65) were detected. Calcitriol 0.25 μ/day was added to her treatment. Her parkinsonism disappeared after the treatment. Case 2 A 49-year-old male patient was consulted when he was admitted to the department of neurology in our hospital. The physical examination demonstrated the characteristics of Albright's hereditary osteodystrophy. The neurological examination shows bilateral symmetrical bradykinesia, dysphagia, and moderate dysarthria. In the laboratory examination PTH: 46.5 ng/L(15-65), Ca:8.6 mg/dL (8.6-10.2), P:2.7 mg/dL (2.3-4.5) were detected and were all within the normal ranges. Consequently, pseudopseudohypoparathyroidism was decided as a diagnosis. G protein alpha subunit mutation (Gsα) was not detected due to technical limitations. Conclusion When a patient is diagnosed as Fahr's syndrome, we should keep in mind parathyroid disorders. Fahr's syndrome must be evaluated in patients showing intracranial calcification accompanied by parathyroid diseases.
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Affiliation(s)
- H Ozisik
- Ege University, Faculty of Medicine, Dept. of Endocrinology, Izmir, Turkey
| | - B S Yürekli
- Ege University, Faculty of Medicine, Dept. of Endocrinology, Izmir, Turkey
| | - R Tuncel
- Ege University, Faculty of Medicine, Dept. of Neurology, Izmir, Turkey
| | - N Ozdemir
- Celal Bayar University, Faculty of Medicine, Dept. of Endocrinology, Manisa, Turkey
| | - M Baklaci
- Ege University, Faculty of Medicine, Dept. of Physical Medicine and Rehabilitation, Izmir, Turkey
| | - O Ekmekci
- Ege University, Faculty of Medicine, Dept. of Neurology, Izmir, Turkey
| | - F Saygili
- Ege University, Faculty of Medicine, Dept. of Endocrinology, Izmir, Turkey
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81
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Manea MM, Sirbu A, Dragos D, Dobri AM, Sirbu AG, Tuta S. EPILEPTIC SEIZURES AS THE FIRST MANIFESTATION OF FAHR'S SYNDROME. ACTA ENDOCRINOLOGICA-BUCHAREST 2020; 16:370-374. [PMID: 33363663 DOI: 10.4183/aeb.2020.370] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Introduction Hypoparathyroidism is a rare endocrine disorder, leading to complications affecting the kidneys, the eyes, the cerebrum (Fahr's syndrome, epilepsy, parkinsonism, cognitive impairment), and the heart. Case report We present the case of a 24-year old male that presented to our clinic for generalized tonic-clonic seizures increasing in frequency for the last year or so. Furthermore, he was diagnosed with subcapsular cataract of both eyes and had intraocular lens implant surgery 12 years ago. CT scan performed at admission showed calcium deposits on the dentate nuclei, basal ganglia, thalamus, cerebellum and bilateral subcortical fronto-parietal white matter compatible with Fahr's disease. The results of the laboratory tests were normal except for hypocalcemia, hyperphosphoremia and low intact parathormone (iPTH). The patient was diagnosed with primary hypoparathyroidism which led to Fahr's syndrome. The patient was prescribed oral medication including calcium carbonate, calcidiol, magnesium orotate and levetiracetam. The follow-up after three months revealed a seizure free status and normalization of magnesium, calcium, and phosphorus levels. Conclusion Fahr's syndrome can be a cause of epileptic seizures and should be considered in the clinical approach to an epileptic patient, especially in children, teenagers, and young adults.
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Affiliation(s)
- M M Manea
- "Carol Davila" University of Medicine and Pharmacy - Neurology, Bucharest, Romania.,National Institute of Neurology and Neurovascular Diseases - Neurology, Bucharest, Romania
| | - A Sirbu
- "Carol Davila" University of Medicine and Pharmacy - Endocrinology, Bucharest, Romania.,University Emergency Hospital Elias - Endocrinology, Bucharest, Romania
| | - D Dragos
- "Carol Davila" University of Medicine and Pharmacy - Medical Semiology, Bucharest, Romania.,University Emergency Hospital Bucharest - Nephrology, Bucharest, Romania
| | - A M Dobri
- National Institute of Neurology and Neurovascular Diseases - Neurology, Bucharest, Romania
| | - A G Sirbu
- National Institute of Neurology and Neurovascular Diseases - MEDINST Imagistic Center, Bucharest, Romania
| | - S Tuta
- "Carol Davila" University of Medicine and Pharmacy - Neurology, Bucharest, Romania.,National Institute of Neurology and Neurovascular Diseases - Neurology, Bucharest, Romania
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82
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Adekanmi A, Bisi A, Akinyemi R. Fahr's disease: Clinicoradiological findings of a rare disease in an adult Nigerian. WEST AFRICAN JOURNAL OF RADIOLOGY 2020. [DOI: 10.4103/wajr.wajr_5_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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83
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Peters MEM, de Brouwer EJM, Bartstra JW, Mali WPTM, Koek HL, Rozemuller AJM, Baas AF, de Jong PA. Mechanisms of calcification in Fahr disease and exposure of potential therapeutic targets. Neurol Clin Pract 2019; 10:449-457. [PMID: 33299674 DOI: 10.1212/cpj.0000000000000782] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Accepted: 10/10/2019] [Indexed: 11/15/2022]
Abstract
Purpose of review There is growing interest in disorders involved in ectopic mineralization. Fahr disease or idiopathic basal ganglia calcification can serve as a model for ectopic mineralization in the basal ganglia, which is fairly common in the general population. In this review, we will focus on causative gene mutations and corresponding pathophysiologic pathways in Fahr disease. Recent findings Patients with Fahr disease have a variability of symptoms, such as movement disorders, psychiatric signs, and cognitive impairment, but can also be asymptomatic. Fahr disease is mostly autosomal dominant inherited, and there are mutations found in 4 causative genes. Mutations in SLC20A2 and XPR1 lead to a disrupted phosphate metabolism involving brain-specific inorganic phosphate transporters. Mutations in PDGFB and PDGFRB are associated with disrupted blood-brain barrier integrity and dysfunctional pericyte maintenance. In addition, the MYORG gene has recently been discovered to be involved in the autosomal recessive inheritance of Fahr. Summary Knowledge about the mutations and corresponding pathways may expose therapeutic opportunities for patients with Fahr disease and vascular calcifications in the brain in general.
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Affiliation(s)
- Melissa E M Peters
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
| | - Esther J M de Brouwer
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
| | - Jonas W Bartstra
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
| | - Willem P Th M Mali
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
| | - Huiberdina L Koek
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
| | - Annemieke J M Rozemuller
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
| | - Annette F Baas
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
| | - Pim A de Jong
- Departments of Radiology (MEMP, JWB, WPTMM, PAdJ), Geriatrics (EJMdB, HLK), Pathology (AJMR), and Genetics (AFB), University Medical Center Utrecht, The Netherlands
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84
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De Silva SW, De Silva SDN, De Silva CE. A patient with extensive cerebral calcification due to pseudohypoparathyroidism: a case report. BMC Endocr Disord 2019; 19:142. [PMID: 31856822 PMCID: PMC6923949 DOI: 10.1186/s12902-019-0475-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 12/11/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Pseudohypoparathyroidism(PHP) is a heterogeneous group of disorders due to impaired activation of c AMP dependant pathways following binding of parathyroid hormone (PTH) to its receptor. In PHP end organ resistance to PTH results in hypocalcaemia, hyperphosphataemia and high PTH levels. CASE PRESENTATION A 59 year old male presented with a history of progressive impairment of speech and unsteadiness of gait for 1 week and acute onset altered behavior for 1 day and one episode of generalized seizure. His muscle power was grade four according to MRC (medical research council) scale in all limbs and Chovstek's and Trousseau's signs were positive. Urgent non contrast computed tomography scan of the brain revealed extensive bilateral cerebral and cerebellar calcifications. A markedly low ionized calcium level of 0.5 mmol/l, an elevated phosphate level of 9.5 mg/dl (reference range: 2.7-4.5 mg/dl) and an elevated intact PTH of 76.3 pg/l were noted. His renal functions were normal. His hypocalcemia was accentuated by the presence of hypomagnesaemia. His 25 hydroxy vitamin D level was only marginally low which could not account for severe hypocalcaemia. A diagnosis of pseudohypoparathyroidism without phenotypic defects, was made due to hypocalcaemia and increased parathyroid hormone levels with cerebral calcifications. The patient was treated initially with parenteral calcium which was later converted to oral calcium supplements. His coexisting Vitamin D deficiency was corrected with 1αcholecalciferol escalating doses. His hypomagnesaemia was corrected with magnesium sulphate parenteral infusions initially and later with oral preparations. With treatment there was a significant clinical and biochemical response. CONCLUSION Pseudohypoparathyroidism can present for the first time in elderly resulting in extensive cerebral calcifications. Identification and early correction of the deficit will result in both symptomatic and biochemical response.
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Affiliation(s)
- S. W. De Silva
- Sri Jayawardenapura General Hospital, Thalapathpitiya, Nugegoda, Sri Lanka
| | - S. D. N. De Silva
- Sri Jayawardenapura General Hospital, Thalapathpitiya, Nugegoda, Sri Lanka
| | - C. E. De Silva
- Sri Jayawardenapura General Hospital, Thalapathpitiya, Nugegoda, Sri Lanka
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85
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Rücker M, Halder W, Kofler M, Ehling R, Brenneis C. Levodopa-responsive dystonia and parkinsonism in Fahr syndrome. Neurol Clin Pract 2019; 9:527-529. [DOI: 10.1212/cpj.0000000000000663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 02/26/2019] [Indexed: 11/15/2022]
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86
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Sarigul B, Seker S, Celik SE. Anterior communicating artery aneurysm in a young patient with Fahr's disease: case presentation. Br J Neurosurg 2019:1-3. [PMID: 31718303 DOI: 10.1080/02688697.2019.1690128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Background and importance: Fahr disease is an uncommon disorder defined as prominent calcification in basal ganglia, dentate nuclei of cerebellum, pulvinar thalami and subcortical white matter and it has been shown that calcium is the major factor that causes the hyperdensity on computer tomography (CT). Spontaneous subarachnoid hemorrhage from an aneurysm in a patient with Fahr disease was first reported by Al-Jehani et al. in 2012 in a 54-year-old female patient with calcification of basal ganglia and deep cerebellar nuclei and a subarachnoid hemorrhage from a right posterior communicating artery aneurysm.Clinical presentation: We present a 17 years old patient with Fahr disease with an anterior communicating artery aneurysm rupture.Conclusion: There are few reports of intracranial hemorrhage with Fahr's disease. It may be suggested that excessive calcium accumulation contributes to aneurysm formation or rupture.
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Affiliation(s)
- Buse Sarigul
- Department of Neurosurgery, Okmeydani Egitim ve Arastirma Hastanesi, Okmeydani, Istanbul, Turkey
| | - Selim Seker
- Department of Neurosurgery, Okmeydani Egitim ve Arastirma Hastanesi, Okmeydani, Istanbul, Turkey
| | - Suat Erol Celik
- Department of Neurosurgery, Okmeydani Egitim ve Arastirma Hastanesi, Okmeydani, Istanbul, Turkey
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87
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Zhou YY, Yang Y, Qiu HM. Hypoparathyroidism with Fahr’s syndrome: A case report and review of the literature. World J Clin Cases 2019; 7:3662-3670. [PMID: 31750351 PMCID: PMC6854411 DOI: 10.12998/wjcc.v7.i21.3662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 09/24/2019] [Accepted: 10/05/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Hypoparathyroidism with basal ganglia calcification is clinically rare. Here, we report a case of Fahr’s syndrome due to hypoparathyroidism and review the literature in terms of etiology, clinical manifestation, diagnosis, and treatment.
CASE SUMMARY A 62-year-old man experienced repeated twitching of both hands in recent 10 years. On July 28, 2017, the patient was admitted to our hospital due to slow response and speech difficulties. On medical examinations, he had a positive Chvostek sign, while no Albright’s hereditary osteodystrophy signs or history of neck surgery or radiation, and his family members had no similar medical history. Laboratory examinations revealed hypocalcemia, hyperphosphatemia, and low parathyroid hormone (PTH) levels. Computed tomography revealed basal ganglia calcification. Based on these investigations, a diagnosis of Fahr’s syndrome due to hypoparathyroidism was suggested. After receiving intravenous calcium gluconate to relieve symptoms, the patient continued to take oral calcium carbonate and calcitriol for treatment.
CONCLUSION The possibility of hypoparathyroidism should be considered in patients with chronic hypocalcemia, recurrent tetany, and even neuropsychiatric symptoms. Hypoparathyroidism is a common cause of basal ganglia calcification. Therefore, it is recommended that blood calcium, phosphorus, and PTH levels should be measured in all individuals with basal ganglia calcification to exclude hypoparathyroidism.
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Affiliation(s)
- Yuan-Yuan Zhou
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital of Kunming Medical University and The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
- Department of Endocrinology and Metabolism, Sixth Affiliated Hospital of Kunming Medical University and The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
| | - Ying Yang
- Department of Endocrinology and Metabolism, Fourth Affiliated Hospital of Kunming Medical University and The Second People’s Hospital of Yunnan Province, Kunming 650021, Yunnan Province, China
| | - Hong-Mei Qiu
- Department of Endocrinology and Metabolism, Sixth Affiliated Hospital of Kunming Medical University and The People’s Hospital of Yuxi City, Yuxi 653100, Yunnan Province, China
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88
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Thillaigovindan R, Arumugam E, Rai R, R P, Kesavan R. Idiopathic Basal Ganglia Calcification: Fahr's Syndrome, a Rare Disorder. Cureus 2019; 11:e5895. [PMID: 31772865 PMCID: PMC6839755 DOI: 10.7759/cureus.5895] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Fahr’s syndrome is a rare neurological disorder with varied clinical manifestations. It is characterized by the progressive deposition of calcium in the walls of the blood vessels of basal ganglia and dentate nuclei of the cerebellum in young and middle-aged people. It is important for neurologists, geneticists, psychiatrists, dentists, and other appropriate care specialists to have a thorough knowledge of this syndrome as any of them could be the first person to diagnose the disease. This case report of Fahr’s syndrome presents the signs and symptoms of the patient and the treatment for oral conditions were done.
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Affiliation(s)
| | - Eswaran Arumugam
- Prosthodontics, Thai Moogambigai Dental College and Hospital, Chennai, IND
| | - Rathika Rai
- Prosthodontics, Thai Moogambigai Dental College and Hospital, Chennai, IND
| | - Prabhu R
- Prosthodontics, Thai Moogambigai Dental College & Hospital, Chennai, IND
| | - R Kesavan
- Public Health Dentistry, Thai Moogambigai Dental College & Hospital, Chennai, IND
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89
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Pathological Mineralization: The Potential of Mineralomics. MATERIALS 2019; 12:ma12193126. [PMID: 31557841 PMCID: PMC6804219 DOI: 10.3390/ma12193126] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 09/11/2019] [Accepted: 09/19/2019] [Indexed: 12/11/2022]
Abstract
Pathological mineralization has been reported countless times in the literature and is a well-known phenomenon in the medical field for its connections to a wide range of diseases, including cancer, cardiovascular, and neurodegenerative diseases. The minerals involved in calcification, however, have not been directly studied as extensively as the organic components of each of the pathologies. These have been studied in isolation and, for most of them, physicochemical properties are hitherto not fully known. In a parallel development, materials science methods such as electron microscopy, spectroscopy, thermal analysis, and others have been used in biology mainly for the study of hard tissues and biomaterials and have only recently been incorporated in the study of other biological systems. This review connects a range of soft tissue diseases, including breast cancer, age-related macular degeneration, aortic valve stenosis, kidney stone diseases, and Fahr’s syndrome, all of which have been associated with mineralization processes. Furthermore, it describes how physicochemical material characterization methods have been used to provide new information on such pathologies. Here, we focus on diseases that are associated with calcium-composed minerals to discuss how understanding the properties of these minerals can provide new insights on their origins, considering that different conditions and biological features are required for each type of mineral to be formed. We show that mineralomics, or the study of the properties and roles of minerals, can provide information which will help to improve prevention methods against pathological mineral build-up, which in the cases of most of the diseases mentioned in this review, will ultimately lead to new prevention or treatment methods for the diseases. Importantly, this review aims to highlight that chemical composition alone cannot fully support conclusions drawn on the nature of these minerals.
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90
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Abstract
Fahr disease, also known as familial idiopathic basal ganglia calcification, is a rare neurodegenerative disorder, the etiology of which remains unknown. Given its various presentations, Fahr disease is presumed to be underdiagnosed and its prevalence underestimated. We present a case of Fahr disease that presented mainly with pure psychiatric symptoms. Isolated psychiatric symptoms without neurological manifestations are rarely seen in patients diagnosed with Fahr disease. Psychiatrists should consider Fahr disease as a differential diagnosis in the evaluation of psychiatric illness.
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91
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Commentary on "Basal Ganglia Calcification: A Case Report of Fahr Disease With Pure Psychiatric Symptoms". J Psychiatr Pract 2019; 25:391-394. [PMID: 31505527 DOI: 10.1097/pra.0000000000000411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Fahr disease, also known as familial idiopathic basal ganglia calcification, is a rare neurodegenerative disorder, the etiology of which remains unknown. Given its various presentations, Fahr disease is presumed to be underdiagnosed and its prevalence underestimated. We present a case of Fahr disease that presented mainly with pure psychiatric symptoms. Isolated psychiatric symptoms without neurological manifestations are rarely seen in patients diagnosed with Fahr disease. Psychiatrists should consider Fahr disease as a differential diagnosis in the evaluation of psychiatric illness.
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92
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Jeon I, Cho KH, Kim SW. Concomitant Fahr's syndrome and thoracic ossification of the posterior longitudinal ligament caused by idiopathic hypoparathyroidism - case report. BMC Musculoskelet Disord 2019; 20:362. [PMID: 31391033 PMCID: PMC6686407 DOI: 10.1186/s12891-019-2747-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 07/31/2019] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Fahr's syndrome presenting multiple and symmetric calcification of basal ganglia and cerebral cortex is rare, and idiopathic hypoparatyroidism is known as one of the causes. The relationship between ossification of posterior longitudinal ligament (OPLL) and idiopathic hypoparatyroidism is also reported in a few cases. Here, we report a patient presenting concomitant Fahr's syndrome and thoracic OPLL developed by idiopathic hypoparatyroidism. CASE PRESENTATION 53-year-old female patient presented myelopathic sign including gait disturbance and both leg weakness (Grade 3) for 4 months after slip down, and has the history of anti-epileptic medication for several years. Magnetic resonance imaging revealed cord compression by the mixed-type OPLL from T5 to T9, and decompressive surgery was planned. Sudden onset generalized tonic-clonic seizure attack developed before the surgery. Hypocalcemia (3.7 mg/dL) with QT prolongation on electrocardiogram, hypomagnesemia (1.4 mg/dL), hyperphosphatemia (7.7 mg/dL), hypoparathyroidism, and normal range of vitamin D was noted. Brain study showed Fahr's syndrome with multiple and symmetric calcification of basal ganglia, cerebral cortex, and cerebellum. Decompressive laminectomy was performed after transient correction of hypocalcemia. The myelopathic symptoms improved to normal walking by the 14-month follow-up. The cause of hypoparathyroidism was concluded to be idiopathic. CONCLUSION Concomitant expression of Fahr's syndrome and OPLL related with idiopathic hypoparatyroidism is very rare. However, we recommend considering the possibility of hypoparathyroidism and Fahr's syndrome when we evaluate the patients with OPLL to avoid the risks of sudden onset seizure and cardiac arrhythmia due to cerebral lesions and hypocalcemia.
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Affiliation(s)
- Ikchan Jeon
- Department of Neurosurgery, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea.
| | - Kyu Hyang Cho
- Department of Nephrology, Yeungnam University Hospital, Daegu, South Korea
| | - Sang Woo Kim
- Department of Neurosurgery, Yeungnam University College of Medicine, 170, Hyeonchung street, Nam-Gu, Daegu, 42415, South Korea
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93
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Donzuso G, Mostile G, Nicoletti A, Zappia M. Basal ganglia calcifications (Fahr's syndrome): related conditions and clinical features. Neurol Sci 2019; 40:2251-2263. [PMID: 31267306 PMCID: PMC6817747 DOI: 10.1007/s10072-019-03998-x] [Citation(s) in RCA: 66] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 06/26/2019] [Indexed: 12/12/2022]
Abstract
Basal ganglia calcifications could be incidental findings up to 20% of asymptomatic patients undergoing CT or MRI scan. The presence of neuropsychiatric symptoms associated with bilateral basal ganglia calcifications (which could occur in other peculiar brain structures, such as dentate nuclei) identifies a clinical picture defined as Fahr's Disease. This denomination mainly refers to idiopathic forms in which no metabolic or other underlying causes are identified. Recently, mutations in four different genes (SLC20A2, PDGFRB, PDGFB, and XPR1) were identified, together with novel mutations in the Myogenic Regulating Glycosylase gene, causing the occurrence of movement disorders, cognitive decline, and psychiatric symptoms. On the other hand, secondary forms, also identified as Fahr's syndrome, have been associated with different conditions: endocrine abnormalities of PTH, such as hypoparathyroidism, other genetically determined conditions, brain infections, or toxic exposure. The underlying pathophysiology seems to be related to an abnormal calcium/phosphorus homeostasis and transportation and alteration of the blood-brain barrier.
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Affiliation(s)
- Giulia Donzuso
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Giovanni Mostile
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Alessandra Nicoletti
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy
| | - Mario Zappia
- Department "GF Ingrassia", Section Neuroscience, University of Catania, Via Santa Sofia 78, 95123, Catania, Italy.
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94
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Wang XT, Cai XY, Xu FX, Zhou L, Zheng R, Ma KY, Xu ZH, Shen Y. MEA6 Deficiency Impairs Cerebellar Development and Motor Performance by Tethering Protein Trafficking. Front Cell Neurosci 2019; 13:250. [PMID: 31244610 PMCID: PMC6580151 DOI: 10.3389/fncel.2019.00250] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 05/20/2019] [Indexed: 11/13/2022] Open
Abstract
Meningioma expressed antigen 6 (MEA6), also called cutaneous T cell lymphoma-associated antigen 5 (cTAGE5), was initially found in tumor tissues. MEA6 is located in endoplasmic reticulum (ER) exit sites and regulates the transport of collagen, very low density lipoprotein, and insulin. It is also reported that MEA6 might be related to Fahr's syndrome, which comprises neurological, movement, and neuropsychiatric disorders. Here, we show that MEA6 is critical to cerebellar development and motor performance. Mice with conditional knockout of MEA6 (Nestin-Cre;MEA6F/F) display smaller sizes of body and brain compared to control animals, and survive maximal 28 days after birth. Immunohistochemical and behavioral studies demonstrate that these mutant mice have defects in cerebellar development and motor performance. In contrast, PC deletion of MEA6 (pCP2-Cre;MEA6F/F) causes milder phenotypes in cerebellar morphology and motor behaviors. While pCP2-Cre;MEA6F/F mice have normal lobular formation and gait, they present the extensive self-crossing of PC dendrites and damaged motor learning. Interestingly, the expression of key molecules that participates in cerebellar development, including Slit2 and brain derived neurotrophic factor (BDNF), is significantly increased in ER, suggesting that MEA6 ablation impairs ER function and thus these proteins are arrested in ER. Our study provides insight into the roles of MEA6 in the brain and the pathogenesis of Fahr's syndrome.
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Affiliation(s)
- Xin-Tai Wang
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Xin-Yu Cai
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Fang-Xiao Xu
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Lin Zhou
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Rui Zheng
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Kuang-Yi Ma
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
| | - Zhi-Heng Xu
- State Key Laboratory of Molecular Developmental Biology, CAS Center for Excellence in Brain Science and Intelligence Technology, Institute of Genetics and Developmental Biology Chinese Academy of Sciences, Beijing, China
| | - Ying Shen
- Department of Neurobiology, NHC and CAMS Key Laboratory of Medical Neurobiology, Zhejiang University School of Medicine, Hangzhou, China
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95
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Ooi HW, Er C, Hussain I, Kuthiah N, Meyyur Aravamudan V. Bilateral Basal Ganglia Calcification: Fahr's Disease. Cureus 2019; 11:e4797. [PMID: 31396467 PMCID: PMC6679705 DOI: 10.7759/cureus.4797] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Fahr's disease/syndrome is a condition defined as bilateral striato-pallido-dentate calcinosis, a neurodegenerative disease with radiological findings of symmetrical and bilateral idiopathic calcifications of the cerebellum, periventricular white matter, and basal ganglia. Clinical correlation with radiological and a calcium metabolism panel is crucial in differentiating between Fahr's disease and Fahr's syndrome. We describe a case that presented with the clinical feature of a cerebrovascular accident and had an incidental radiological finding of Fahr syndrome. The clinical features, laboratory investigations, and clinical management of Fahr's disease/syndrome will be discussed in detail in the article.
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Affiliation(s)
- Hsein Wei Ooi
- Miscellaneous, Ministry of Health Holdings, Singapore, SGP
| | - Chaozer Er
- Internal Medicine, Woodlands Health Campus, Singapore, SGP
| | - Ikram Hussain
- Internal Medicine, Woodlands Health Campus, Singapore, SGP
| | - Navin Kuthiah
- General Medicine, Woodlands Health Campus, Singapore, SGP
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96
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Dembélé K, Cissé L, Djimdé S, Coulibaly Y, Diarra S, Yalcouyé A, Maiga B, Guinto CO, Landouré G. Fahr's syndrome with hyperparathyroidism revealed by seizures and proximal weakness. eNeurologicalSci 2019; 15:100192. [PMID: 31080899 PMCID: PMC6504845 DOI: 10.1016/j.ensci.2019.100192] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 04/23/2019] [Indexed: 11/19/2022] Open
Affiliation(s)
- Kékouta Dembélé
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
| | - Lassana Cissé
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
| | - Samba Djimdé
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
| | - Youlouza Coulibaly
- Service d'Imagerie Médicale, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
| | - Salimata Diarra
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
| | | | - Boubacar Maiga
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
| | - Cheick O. Guinto
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
- Faculté de Médecine et d'Odontostomatologie, USTTB, Bamako, Mali
| | - Guida Landouré
- Service de Neurologie, Centre Hospitalier Universitaire du Point "G", Bamako, Mali
- Faculté de Médecine et d'Odontostomatologie, USTTB, Bamako, Mali
- Corresponding author at: Faculté de Médecine et d'Odontostomatologie, Université des Sciences, des Techniques et des Technologies de Bamako, Point “G”, PO Box: 1805, Bamako, Mali.
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97
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Jang BH, Son SW, Kim CR. Fahr's Disease With Intracerebral Hemorrhage at the Uncommon Location: A Case Report. Ann Rehabil Med 2019; 43:230-233. [PMID: 31072090 PMCID: PMC6509574 DOI: 10.5535/arm.2019.43.2.230] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 09/13/2018] [Indexed: 01/30/2023] Open
Abstract
Fahr’s disease (FD) is a rare neurologic disorder characterized by the symmetric and bilateral intracerebral calcification in a patient. We describe the case of a 65-year-old woman who presented with gait disturbance, abnormal mentality, and visual field defect. The result of a brain computerized tomography showed spontaneous intracranial hemorrhage in the right parieto-occipital area, and also showed the incidence of symmetric and bilateral intracerebral calcification. Moreover, laboratory studies indicated characteristic hypoparathyroidism. This brings us to understand that additionally, one of her sons also presented with similar intracerebral calcification, and was subsequently diagnosed with FD. Thus, her case was consistent with that of a patient experiencing FD. The patient had hypertension, which we now know might have caused the intracerebral hemorrhage. However, this patient’s brain lesions were in uncommon locations for spontaneous intracerebral hemorrhage, and the lesions were noted as occurring away from the identified heavily calcified areas. Thus, it seemed that the massive calcification of cerebral vessels in the basal ganglia, the most common site of intracerebral hemorrhage, might have prevented a hypertensive intracerebral hemorrhage. Eventually, an intracerebral hemorrhage occurred in an uncommon location in the patient’s brain.
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Affiliation(s)
- Baek Hee Jang
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan, Korea
| | - Seong Wook Son
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan, Korea
| | - Chung Reen Kim
- Department of Physical Medicine and Rehabilitation, Ulsan University Hospital, Ulsan, Korea
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98
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Rissardo J, Fornari Caprara A, Freitas Silveira J. Fahr's disease presenting with pure dementia: A case report and literature review. APOLLO MEDICINE 2019. [DOI: 10.4103/am.am_54_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
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99
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Lee YJ, Park S, Kim YW, Park KM, Kim IH, Park JH, Park BS. A Case of Seizure Revealing Fahr's Syndrome with Primary Hypoparathyroidism. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1430-1433. [PMID: 30504755 PMCID: PMC6287451 DOI: 10.12659/ajcr.913382] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
Patient: Male, 52 Final Diagnosis: Fahr’s syndrome Symptoms: Seizure Medication: — Clinical Procedure: — Specialty: Endocrinology and Metabolic
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Affiliation(s)
- Yoo Jin Lee
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Sihyung Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Yang Wook Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Kang Min Park
- Department of Neurology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Il Hwan Kim
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Jin Han Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
| | - Bong Soo Park
- Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, South Korea
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100
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Iwase T, Yoshida M, Hashizume Y, Yazawa I, Takahashi S, Ando T, Ikeda T, Nokura K. Intracranial vascular calcification with extensive white matter changes in an autopsy case of pseudopseudohypoparathyroidism. Neuropathology 2018; 39:39-46. [PMID: 30430658 DOI: 10.1111/neup.12518] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 09/12/2018] [Accepted: 09/13/2018] [Indexed: 01/31/2023]
Abstract
We herein report an autopsy case of a 69-year-old man with pseudopseudohypoparathyroidism. The patient suffered from mental retardation and spastic tetraparesis and had all the features of Albright's hereditary osteodystrophy with a normal response to parathyroid hormone in the Ellsworth-Howard test. Computed tomography demonstrated symmetrical massive brain calcification involving the bilateral basal ganglia, thalami, dentate nuclei and cerebral gray/white matter junctions, which was consistent with Fahr's syndrome. Magnetic resonance imaging revealed extensive white matter changes sparing the corpus callosum. Severe ossification of the posterior longitudinal ligament of the cervical spine was also demonstrated. A neuropathological examination revealed massive intracranial calcification within the walls of the blood vessels and capillaries with numerous calcium deposits. The calcium deposits aligned along the capillaries, and deposits in the vessel wall at the initial stage were confined to the border between the tunica media and adventitia. The vascular calcification in the basal ganglia continuously spread over the surrounding white matter into the cortex. The area of vascular calcification in the white matter was very well correlated with the area of the attenuated myelin staining. Axonal loss, myelin sheath loss and gliosis were observed in the white matter with severe vascular calcification. We should recognize the continuous area of vascular calcification and its correlation with extensive white matter changes as possible causes of neuropsychiatric symptoms in pseudopseudohypoparathyroidism with Fahr's syndrome.
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Affiliation(s)
- Tamaki Iwase
- Department of Neurology, Nagoya City Koseiin Medical Welfare Center, Aichi, Japan
| | - Mari Yoshida
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan
| | - Yoshio Hashizume
- Institute for Neuropathology, Fukushimura Hospital, Aichi, Japan
| | - Ikuru Yazawa
- Laboratory of Research Resources, Research Institute, National Center for Geriatrics and Gerontology, Aichi, Japan
| | - Seishiro Takahashi
- Department of Experimental Pathology and Tumor Biology, Nagoya City University Graduate School of Medical Sciences, Aichi, Japan
| | - Takashi Ando
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan.,Department of Neurology, Nagoya University Graduate School of Medicine, Aichi, Japan
| | - Toshimasa Ikeda
- Department of Neuropathology, Institute for Medical Science of Aging, Aichi Medical University, Aichi, Japan.,Department of Neurology and Neuroscience, Nagoya City University, Graduate School of Medical Sciences, Aichi, Japan
| | - Kazuya Nokura
- Department of Neurology, Ban Buntane Hotokukai Hospital, School of Medicine, Fujita Health University, Aichi, Japan
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