[Intracranial calcification on computer tomography a comparison with radiography (author's transl)]

Intracranial bilateral symmetrical calcification on CT-scanning. A case report and a review of the literature

The case of a 57-year-old woman with idiopathic hypoparathyroidism is presented. A CT-scan showed extensive bilateral symmetrical calcification in the region of the basal ganglia, nuclei of the cerebellum and the cerebral and cerebellar white matter. A review of the literature showed that bilateral symmetrical calcification detected by CT is usually small in extent and is most often confined to the globus pallidus. It is most commonly found in patients older than 50 years, who only rarely have symptoms associated with it. The finding is, though, non-specific and may occur in a variety of pathological conditions both with and without an aetiological relationship. Further study of the cerebral parathormone responsive adenylate cyclase enzyme proves hopeful to elucidate the aetiology of idiopathic bilateral symmetrical calcification.

Basal ganglia calcification. Characteristics of CT scans and clinical findings

Intracranial calcifications are attributed to many diseases. The globus pallidus is almost always the site of bilateral idiopathic calcium deposits. Computed tomography is superior to conventional skull radiographs in detecting intracranial calcifications. Patients had symptoms that were often explained by other findings. Basal ganglia calcification alone is not a nosological entity and does not justify invasive diagnostic procedures.

[Clinical, endocrinological, and computerized tomography scans for symmetrical calcification of the basal ganglia (author's transl)]

Symmetrical calcification of the basal ganglia was found in 2% of 8000 computerized tomography (CT) scans. Of 19 cases, only 2 were detectable on conventional skull films. The less prominent calcifications were most often found in the region of the pallidum, the knee of the internal capsule. Also, the lesions were generally symmetrical. Thus these factors must be considered basic morphological characteristics of the pathophysiological process. Additional neurological disorders were present in 6 patients. Neurological symptoms in the remaining 13, when present, depended on the extent of the lesion. The most common finding was tremor, although disturbances of fine motor control, transient lateralizing signs, and seizures were also noted. No particular constellation of symptoms or signs permitted accurate clinical localization of the lesions. The patients could be divided into three groups on the basis of clinical findings: (1) young people with marked cerebral calcinosis ('idiopathic' calcification of basal ganglia), (2) patients with hypoparathyroidism, and (3) older patients with relatively little calcification. Most patients with calcific lesions will be included in the third group. Any calcification of basal ganglia detected by CT scans demands careful evaluation of calcium metabolism.

Unsuccessful treatment with levodopa of a parkinsonian patient with calcification of the basal ganglia

A patient aged 67 had suffered from hypoparathyroidism (tetany and cataracts) following thyroidectomy at the age of 20, although treated with AT 10. During the last few years there had been a change of gait to small steps and general retardation. Nocturnal epileptic attacks occurred in the last year which led to the admission to hospital where a well developed parkinsonian syndrome without tremor was observed. X-rays of the skull, including computed tomograms, revealed calcification of the basal ganglia and dentate nuclei. Treatment with levodopa was ineffective. The mechanism for this is discussed.