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Pinto CJ, Agrawal H, Schmidt H, Tumah L. Fahr's disease in a patient with recurrent pneumonias, parkinsonism and dementia. BMJ Case Rep 2024; 17:e258470. [PMID: 38296507 PMCID: PMC10831457 DOI: 10.1136/bcr-2023-258470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2024] Open
Abstract
Fahr's disease is a rare condition characterised by the presence of idiopathic familial bilateral basal ganglia calcifications, transmitted in an autosomal-dominant fashion. Diagnosis is based on clinical features of neuropsychiatric and somatic symptoms in conjunction with radiological findings. Our patient, a man in his early 50s, presented with pneumonia. History was significant for five admissions in the last 2 years for pneumonia and falls, with gradual cognitive and motor decline since his late 30s. Hypophonia, bradykinesia and dementia were noted on examination. CT of the brain revealed bilateral thalamic calcinosis, consistent with Fahr's syndrome. Further investigations and retrospective history taking, and similar radiological findings within first-degree and second-degree relatives with early deaths, transitioned the diagnosis from Fahr's syndrome to Fahr's disease. We present this case of Fahr's disease to emphasise the value of collaboration among multidisciplinary professionals to improve quality of care for such patients.
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Affiliation(s)
- Christopher Jude Pinto
- Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
- Department of Medicine, Karnataka Institute of Medical Sciences Hubballi, Hubli, India
| | - Harshita Agrawal
- Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Holly Schmidt
- Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
| | - Layth Tumah
- Department of Family Medicine, Western Michigan University Homer Stryker MD School of Medicine, Kalamazoo, Michigan, USA
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Adhikari S, Bhate A, Patil S, Kalawatia M, Sangoi R, Palande A, Kamble P, Mittal G. A Case Report of Fahr's Disease and Its Clinical Heterogeneity. Cureus 2023; 15:e51065. [PMID: 38269217 PMCID: PMC10806376 DOI: 10.7759/cureus.51065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 12/25/2023] [Indexed: 01/26/2024] Open
Abstract
Fahr's disease is an exceptionally rare and complex neurological disorder characterized by abnormal calcium deposition in the basal ganglia and cerebral cortex. This case report presents a 27-year-old female with Fahr's disease, showcasing the striking clinical diversity and challenging diagnostic landscape associated with this condition. Despite its rarity, Fahr's disease can have a profound impact on patients, manifesting as a spectrum of neurological symptoms, cognitive deficits, and motor impairment. Recent advancements in research have illuminated genetic aspects, offering potential avenues for enhanced diagnostic accuracy and therapeutic interventions. Treatment for Fahr's disease remains primarily supportive, targeting neuropsychiatric symptoms and seizure prophylaxis. Our case highlights the unique presentation of a young female patient with Fahr's disease, challenging conventional demographic profiles and emphasizing the need for individualized patient assessments. The utilization of non-contrast CT scans in diagnosis underscores the importance of appropriate imaging techniques, given the diverse clinical manifestations of this condition. This case adds to the growing understanding of Fahr's disease, emphasizing its clinical heterogeneity and advancing the quest for tailored approaches to diagnosis and intervention.
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Affiliation(s)
| | - Archana Bhate
- General Medicine, Dr. D. Y. Patil Medical College, Navi Mumbai, IND
| | - Smita Patil
- General Medicine, Dr. D. Y. Patil Medical College, Navi Mumbai, IND
| | - Mihit Kalawatia
- Medicine, Rajarshee Chatrapati Shahu Maharaj Government Medical College, Kolhapur, IND
| | - Ravi Sangoi
- Internal Medicine, Punyashlok Ahilyadevi Holkar Government Medical College and General Hospital, Baramati, Baramati, IND
| | | | | | - Gaurav Mittal
- Research and Development, Rotaract Club of Indian Medicos, Mumbai, IND
- Research, Students Network Organization, Mumbai, IND
- Internal Medicine, Mahatma Gandhi Institute of Medical Sciences, Wardha, IND
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3
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Zhu SH, Peng JJ, Li KF, Peng JC, Li J. Non-ketotic hyperglycaemic hemichorea-hemiballismus with Fahr's disease in a Chinese family: a case report. Int J Neurosci 2023; 133:1242-1246. [PMID: 35510430 DOI: 10.1080/00207454.2022.2074846] [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: 12/19/2021] [Revised: 04/18/2022] [Accepted: 04/27/2022] [Indexed: 11/08/2022]
Abstract
INTRODUCTION Non-ketotic hyperglycaemic hemichorea-hemiballismus (NHHH) is often secondary to middle-aged and elderly diabetic people with poor-controlled diabetes; Fahr's disease (FD) is another rare neurological disorder characterized by abnormal calcified deposits in the brain that control movement. We described a rare case of NHHH combined with a heterozygous mutation (SLC20A2) resulting in one family with FD. CASE PRESENTATION The patient has a 30-day history of involuntary choreic movements of the left limbs and left face. In addition, he had a bit of speech slurred and walked unsteadily. He was diagnosed with type 2 diabetes mellitus two months ago. Over the past two months, he had noticed that urination, appetite, and water volume increased obviously and weight loss drastically. Other problems such as dizziness, headache, difficulty swallowing, nausea, and vomiting did not occur. T1- weighted MRI indicts characteristic contralateral basal ganglia hyper-intensity. During hospitalization, he was injected insulin and oral haloperidol. And the clinical symptoms improved, but parkinsonism symptoms emerge soon after discharge. The parkinsonism symptoms were gradually improved after adjusting medications. Combined with the subsequent genetic test results, we attribute it to NHHH with FD. CONCLUSION It is relatively rare that NHHH or FD is both presents. We should use antipsychotics with caution in these patients to avoid parkinsonism symptoms.
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Affiliation(s)
- Si-Huan Zhu
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Graduate School, Anhui University of Traditional Chinese Medicine
| | - Jin-Jin Peng
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Graduate School, Anhui University of Traditional Chinese Medicine
| | - Ke-Fan Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Graduate School, Anhui University of Traditional Chinese Medicine
| | - Jian-Cheng Peng
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Graduate School, Anhui University of Traditional Chinese Medicine
| | - Jun Li
- Department of Neurology, The First Affiliated Hospital of Anhui University of Traditional Chinese Medicine, Hefei, China
- Graduate School, Anhui University of Traditional Chinese Medicine
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Sarna MK, Goel P, Bhargava V, Parakh R. Fahr's syndrome associated with hypoparathyroidism: A case report. J R Coll Physicians Edinb 2023; 53:283-287. [PMID: 37936282 DOI: 10.1177/14782715231210606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Fahr's syndrome affects fewer than 1 in 100,000 people. It is an inherited neurological disorder, which is distinguished by atypical calcium deposition in the movement-controlling areas of brain, that is thalamus, dentate nucleus, basal ganglia, cerebellum, cerebral cortex, hippocampus and subcortical white matter. The majority of patients often experience extrapyramidal symptoms, cerebellar signs, speech difficulty, dementia and neuropsychiatric manifestations. This disease's molecular genetics have not been thoroughly investigated. Typically, young to middle-aged adults are affected though basal ganglia calcification in hypoparathyroidism is quite uncommon. Laboratory results and radiographic brain imaging helps in reaching the diagnosis. The treatment is mainly symptomatic. We present a case of Fahr's syndrome associated with hypoparathyroidism.
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Affiliation(s)
- Mukesh Kumar Sarna
- Department of General Medicine, Mahatma Gandhi Medical College and Hospital, Jaipur, India
| | - Pallaavi Goel
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| | - Varun Bhargava
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
| | - Rishabh Parakh
- Mahatma Gandhi University of Medical Science & Technology, Jaipur, India
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Choayb S, El Harras Y, Lahfidi A, Touarsa F, Fikri M, Ech-Cherif El Kettani N, Jiddane M. A rare case of Fahr disease revealed by an epileptic seizure. Radiol Case Rep 2023; 18:1954-1956. [PMID: 36970236 PMCID: PMC10030808 DOI: 10.1016/j.radcr.2023.02.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Accepted: 02/18/2023] [Indexed: 03/19/2023] Open
Abstract
Fahr's disease is a rare neurodegenerative disorder, identified by bilateral and symmetrical intracerebral calcifications of mainly the basal ganglia. Patients often present extrapyramidal or neuropsychological symptoms. Seizure is one of the rarest manifestations that can reveal Fahr disease. We present the case of a 47-year-old male patient who had Fahr disease revealed by an inaugural tonic-clonic seizure.
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Aghemo K, Salmanzadeh R, DeAngelo O, Salmanzadeh AM. Advanced Early-Onset Fahr's Disease: A Case Report. Cureus 2023; 15:e39495. [PMID: 37362501 PMCID: PMC10290546 DOI: 10.7759/cureus.39495] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Fahr's disease is a rare disorder characterized by abnormal calcium deposition within the basal ganglia, cerebellar dentate nuclei, and white matter tracts with subsequent atrophy. Typical CT imaging features include extensive symmetric calcification involving the basal ganglia and subcortical white matter. Primary Fahr's disease (also known as primary familial brain calcification) is diagnosed based on the exclusion of secondary causes such as underlying metabolic or endocrine disorders. The disease may or may not feature a detectable genetic component, which is inherited in an autosomal dominant or recessive pattern. Fahr's disease typically presents in the fourth to fifth decade of life and often manifests clinically with movement disorders and/or neuropsychiatric symptoms ranging from memory/concentration deficits to psychosis. Fahr's disease is not fully understood and is often misdiagnosed in psychiatric patients, thus further literature and documentation of characteristic imaging findings would prove helpful when the diagnosis is suspected. We demonstrate a very radiologically advanced case of Fahr's disease particularly in terms of calcifications in a contrastingly young patient with atypical clinical findings of gait abnormalities, microcephaly, and schizophrenia. Although genetic testing and family history were unavailable for this patient, the profound imaging and symptom presentations should serve to expand the awareness and understanding of a Fahr's disease diagnosis in younger and older patients alike.
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Bhardwaj R, Dhawan A, Singh S, Saha I, Singh A. Fahr's syndrome and optic nerve head calcification in young: A rare consortium. JOURNAL OF CLINICAL OPHTHALMOLOGY AND RESEARCH 2023. [DOI: 10.4103/jcor.jcor_57_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023] Open
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Iki S, Shimizu H, Morimoto Y, Yamamoto N, Ohashi A, Tayama T, Imamura A, Ozawa H. Intracranial calcification and psychotic symptoms after irradiation in a patient with Fanconi anemia: A case report. PCN REPORTS : PSYCHIATRY AND CLINICAL NEUROSCIENCES 2022; 1:e10. [PMID: 38868643 PMCID: PMC11114304 DOI: 10.1002/pcn5.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 03/02/2022] [Accepted: 03/22/2022] [Indexed: 06/14/2024]
Abstract
Background Patients with Fanconi anemia (FA) are at high risk for the development of malignancies, and are often treated with radiation therapy. Radiation therapy during childhood can cause intracranial calcification after a latent period, which has been associated with psychiatric symptoms. Despite the high sensitivity of patients with FA to radiation, intracranial calcification has rarely been reported in these patients. Case Presentation A 17-year-old girl presented with psychiatric symptoms and cognitive impairment. She had been diagnosed with FA at 3 years old, and had received a bone marrow transplant at 5 years old with a preparative regimen that included total body irradiation. Results of IQ tests revealed a characteristic pattern of decline between the ages of 15 and 17 years. Computed tomography indicated multiple intracranial calcifications in regions associated with psychotic symptoms, including the frontal lobe and thalamus. The patient's psychiatric symptoms improved with the administration of blonanserin. Limitations The patient did not have regular intracranial imaging, making it difficult to confirm a direct relationship between intracranial calcification, psychiatric symptoms, and cognitive impairment. It is unclear whether the intracranial calcification in this case can be explained entirely by irradiation. Conclusion This case suggests a link between FA, intracranial calcification, and psychosis, in which intracranial calcification may have caused psychiatric symptoms. At present, evidence regarding the characteristics of psychiatric symptoms of intracranial calcification and its treatment is lacking. The current case will be helpful for elucidating the pathogenesis of this disorder and developing appropriate treatment protocols.
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Affiliation(s)
- Soichiro Iki
- Department of Neuropsychiatry, Unit of Translational MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
| | - Hitomi Shimizu
- Department of Neuropsychiatry, Unit of Translational MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
- Department of PediatricsSaiseikai Nagasaki HospitalNagasakiJapan
| | - Yoshiro Morimoto
- Department of Neuropsychiatry, Unit of Translational MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
| | - Naoki Yamamoto
- Department of Neuropsychiatry, Unit of Translational MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
| | - Aiko Ohashi
- Department of Neuropsychiatry, Unit of Translational MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
| | - Tatsuyuki Tayama
- Department of Neuropsychiatry, Unit of Translational MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
| | - Akira Imamura
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
- Department of Psychiatric Rehabilitation ScienceNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
| | - Hiroki Ozawa
- Department of Neuropsychiatry, Unit of Translational MedicineNagasaki University Graduate School of Biomedical SciencesNagasakiJapan
- Child and Adolescent Psychiatry Community Partnership UnitNagasaki University HospitalNagasakiJapan
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Carbone MG, Della Rocca F. Neuropsychiatric Manifestations of Fahr's Disease, Diagnostic and Therapeutic Challenge: A Case Report and a Literature Review. CLINICAL NEUROPSYCHIATRY 2022; 19:121-131. [PMID: 35601245 PMCID: PMC9112992 DOI: 10.36131/cnfioritieditore20220206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Objective Calcifications in basal ganglia could be an incidental finding up to 20% of asymptomatic patients undergoing computed tomography (CT) or magnetic resonance imaging (MRI) scan. The presence of neuropsychiatric symptomatology associated with basal ganglia calcifications identifies a clinical entity defined as Fahr's Disease. This term is used in presence of calcifications secondary to a specific cause, but the variability of etiology, pathogenesis, and clinical picture underlying this condition have raised the question of the real existence of a syndrome. Several classifications based on the etiology, the location of brain calcifications and the clinical presentation have been proposed. Method In the present study, we describe the case of a 52 years old man with a Bipolar I disorder diagnosis and a recent onset of behavioral disinhibition and alcohol misuse. The patient came to our center, specialized for bipolar disorder, as a consequence of a progressive worsening of the clinical picture associated to behavioral disturbances (sexual disinhibition, episodes of binge-eating, alcohol misuse), initial degrees of deterioration in cognitive function, peculiar psychotic symptoms and a resistance to various psychopharmacological treatment. The patient underwent neuro-psychologic evaluation, laboratory examinations and neuroimaging. Results and Conclusions CT and MRI revealed basal ganglia calcification and, in presence of normal blood tests, a diagnosis of Fahr's syndrome was suggested. During the hospitalization, the patient showed a good clinical response to a psychopharmacological therapy constituted by two mood stabilizers (lithium carbonate and oxcarbazepine) and mild antipsychotics doses (quetiapine and aripiprazole). Finally, we performed a literature review on the complex and multifaceted neuropsychiatric clinical manifestations of Fahr's disease in order to provide useful elements in terms of etiology, clinical manifestation, diagnosis, and treatment.
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Affiliation(s)
- Manuel Glauco Carbone
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Viale Luigi Borri 57, 21100 Varese, Italy,Pisa-School of Experimental and Clinical Psychiatry, University of Pisa, Via Roma 57, 56100, Pisa, Italy.,Corresponding author Manuel Glauco Carbone, M.D. Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Viale Luigi Borri 57, 21100 Varese, Italy E-mail:
| | - Filippo Della Rocca
- Department of Clinical and Experimental Medicine, University of Pisa, Via Roma 57, 56100, Pisa, Italy.,
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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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Intracranial Mönckeberg's Atherosclerosis Is Frequently Found in Autopsy Cases of Advanced Stage Malignancy with Cerebral Infarction. Cancers (Basel) 2021; 13:cancers13205234. [PMID: 34680388 PMCID: PMC8534181 DOI: 10.3390/cancers13205234] [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: 09/23/2021] [Revised: 10/11/2021] [Accepted: 10/18/2021] [Indexed: 02/05/2023] Open
Abstract
Simple Summary We pathologically compared the cerebral infarction (CI) status in autopsy cases with and without malignancy focusing on the status of intracranial Mönckeberg’s atherosclerosis. Most of Mönckeberg’s atherosclerosis were found in the basal ganglia. Its prevalence in CI cases with malignancy was significantly higher than in malignancy cases without CI and was apparently higher than CI cases without malignancy. The results indicated that Mönckeberg’s atherosclerosis was frequently found in the basal ganglia of CI patients with malignancy and that intracranial Mönckeberg’s atherosclerosis is a potential risk factor for CI in patients with advanced stage malignancy. Abstract Cerebral infarction (CI) severely affects the prognosis of patients with malignancy. The aim of the study was to compare the pathology of CI between cases with and without malignancy focusing on intracranial Mönckeberg’s atherosclerosis. Among 778 autopsy cases of craniotomy, 53 cases of “cerebral infarction without malignancy group” (CI group), 50 cases of “malignant tumor without CI group” (MT group), and 39 cases of “cerebral infarction with malignancy group” (CM group) were identified. Mönckeberg’s atherosclerosis was mainly found in the basal ganglia and its prevalence in the CM group (38.5%) was significantly higher than in the MT group (12.0%, p = 0.005), and apparently higher than in the CI group (18.9%, p = 0.057). The CI group was significantly older, had higher BMIs, and a greater prevalence of hypertension and atrial fibrillation compared to the CM group. In addition, the prevalence of chronic renal disease was significantly lower in the CM group (2.6%, p = 0.012) than in the CI group (20.8%). Our results indicated that Mönckeberg’s atherosclerosis was often found in the basal ganglia of CM cases and that intracranial Mönckeberg’s atherosclerosis is a potential risk factor for CI in patients with advanced stage malignancy.
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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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Zavatta G, Tebben PJ, McCollough CH, Yu L, Vrieze T, Clarke BL. Basal Ganglia Calcification Is Associated With Local and Systemic Metabolic Mechanisms in Adult Hypoparathyroidism. J Clin Endocrinol Metab 2021; 106:1900-1917. [PMID: 33788935 DOI: 10.1210/clinem/dgab162] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Indexed: 11/19/2022]
Abstract
CONTEXT Hypoparathyroidism is characterized by low serum calcium, increased serum phosphorus, and inappropriately low or decreased serum parathyroid hormone, which may be associated with soft tissue calcification in the basal ganglia of the brain. OBJECTIVE To assess the prevalence and factors involved in the pathophysiology of basal ganglia calcification (BGC) in the brain in chronic hypoparathyroidism and to evaluate proposed pathophysiologic mechanisms. DESIGN Case-control study with retrospective review of medical records over 20 years. SETTING Single academic medical center. PATIENTS 142 patients with chronic hypoparathyroidism and computed tomography (CT) head scans followed between January 1, 2000 and July 9, 2020, and 426 age- and sex-matched controls with CT head scans over the same interval. INTERVENTIONS None. MAIN OUTCOME MEASURES Demographic, biochemical, and CT head imaging findings, with semiquantitative assessment of volumetric BGC. RESULTS The study found that 25.4% of 142 patients followed for a median of 17 years after diagnosis of chronic hypoparathyroidism had BGC, which developed at a younger age than in controls. BGC was 5.1-fold more common in nonsurgical patients and less common in postsurgical patients. Low serum calcium and low calcium/phosphate ratio correlated with BGC. Neither serum phosphorus nor calcium × phosphate product predicted BGC. Lower serum calcium was associated with greater volume of BGC. The extent of BGC varied widely, with nonsurgical patients generally having a greater volume and distribution of calcification. CONCLUSIONS BGC is associated with low serum calcium and low serum calcium/phosphate ratio, which may be related to severity of the disease, its etiology, or duration of treatment.
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Affiliation(s)
- Guido Zavatta
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | - Peter J Tebben
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
| | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Thomas Vrieze
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Bart L Clarke
- Division of Endocrinology, Diabetes, Metabolism, and Nutrition, Mayo Clinic, Rochester, MN, USA
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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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Zahniser E, Bird TD, Chen DH, Hu SC, Raskind WH, Trittschuh EH. Familial Idiopathic Basal Ganglia Calcification: A Father-Son Dyad Demonstrate Heterogeneity of Presentation and Disease Progression. Arch Clin Neuropsychol 2021; 37:217-225. [PMID: 33893476 DOI: 10.1093/arclin/acab026] [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: 10/20/2020] [Revised: 12/29/2020] [Accepted: 04/02/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Familial idiopathic basal ganglia calcification (FIBGC) is a rare, heritable disease characterized by calcium deposition in the basal ganglia and other brain regions. Clinical presentations are diverse, featuring an array of neurologic, psychiatric, and/or cognitive symptoms. This dyad report presents neurogenetic, neuroimaging, neurological, and serial neuropsychological data from a father (S1) and son (S2) with FIBGC. METHOD/RESULTS The SLC20A2 genetic mutation c.1828-1831delTCCC was identified for each patient, both of whom evidenced similar patterns of brain calcification mainly in the basal ganglia and cerebellum on neuroimaging. S1's onset was in his late 60s with primary motor abnormalities followed by cognitive decline; S2's younger onset (late 30s) was characterized by predominant psychiatric symptoms and mild cognitive changes. Our unique, detailed longitudinal study revealed that both subjects demonstrated largely stable performance across most neuropsychological domains assessed. CONCLUSIONS The subjects' differences in presentation demonstrate the variable expressivity in FIBGC even with the same pathogenic variant within a single family. Distinct phenotypes may be associated with age of onset even in persons with the same mutation, consistent with past research. Disease progression may feature an initial period of notable change from baseline followed by relative stability, as seen both on imaging and neuropsychological evaluation.
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Affiliation(s)
- Evan Zahniser
- VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, Washington 98144, USA
| | - Thomas D Bird
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington 98195, USA.,Department of Medicine (Medical Genetics), University of Washington School of Medicine, Seattle, Washington 98195, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195, USA
| | - Dong-Hui Chen
- Department of Neurology, University of Washington School of Medicine, Seattle, Washington 98195, USA
| | - Shu-Ching Hu
- VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, Washington 98144, USA.,Department of Neurology, University of Washington School of Medicine, Seattle, Washington 98195, USA
| | - Wendy H Raskind
- VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, Washington 98144, USA.,Department of Medicine (Medical Genetics), University of Washington School of Medicine, Seattle, Washington 98195, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195, USA
| | - Emily H Trittschuh
- VA Puget Sound Health Care System, Geriatric Research Education and Clinical Center, Seattle, Washington 98144, USA.,Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195, USA
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Zavatta G, Clarke BL. Basal ganglia calcification in hypoparathyroidism and pseudohypoparathyroidism: local and systemic metabolic mechanisms. J Endocrinol Invest 2021; 44:245-253. [PMID: 32661948 DOI: 10.1007/s40618-020-01355-w] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/04/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Hypoparathyroidism and pseudohypoparathyroidism are rare disorders of mineral metabolism which may be associated with soft tissue calcification in the basal ganglia in the brain, and occasionally the skin and other tissues. The basal ganglia are the most common sites of calcification in the central nervous system in these disorders, and were first associated with this manifestation in a report from the Mayo Clinic in 1939. The reasons why the basal ganglia are a common site of soft tissue calcification in these rare disorders has been a matter of investigation for many years. FINDINGS Due to recent increased understanding of phosphate transport and new insights gained from mRNA expression in the basal ganglia, the pathophysiology of basal ganglia calcification (BGC) is now clearer. There is evidence that the absence of parathyroid hormone in hypoparathyroidism may play a direct role, but this is clearly not the case in pseudohypoparathyroidism, which is associated with increased parathyroid hormone levels. Maintaining the calcium/phosphorus ratio as close to normal as possible, and maintaining normal serum phosphate levels, may help mitigate the progression of BGC. There is no evidence of regression of BGC with conventional treatment, and long-term data with adjunctive or replacement therapy with parathyroid hormone or its analogues are not yet available. PURPOSE OF THE REVIEW This review will focus on the pathophysiology of BGC in hypoparathyroidism and pseudohypoparathyroidism, and review the proposed pathophysiologic mechanisms, as well as the clinical implications of BGC on patient quality of life.
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Affiliation(s)
- G Zavatta
- Mayo Clinic E18-A, 200 1st Street SW, Rochester, MN, 55905, USA
- Department of Medical and Surgical Sciences, University of Bologna, via Massarenti 9, 40138, Bologna, Italy
| | - B L Clarke
- Mayo Clinic E18-A, 200 1st Street SW, Rochester, MN, 55905, USA.
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17
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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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Auffray-Calvier E, Lintia-Gaultier A, Bourcier R, Aguilar Garcia J. [Basal ganglia calcification]. Rev Med Interne 2020; 41:404-412. [PMID: 32165049 DOI: 10.1016/j.revmed.2020.02.016] [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: 07/09/2019] [Revised: 02/06/2020] [Accepted: 02/13/2020] [Indexed: 10/24/2022]
Abstract
Calcifications of the basal ganglia are frequently seen on the cerebral CT scans and particularly in the globus pallidus. Their frequency increases physiologically with age after 50 years old. However, pathological processes can also be associated with calcium deposits in the gray nuclei, posterior fossa or white matter. Unilateral calcification is often related to an acquired origin whereas bilateral ones are mostly linked to an acquired or genetic origin that will be sought after eliminating a perturbation of phosphocalcic metabolism. In pathological contexts, these calcifications may be accompanied by neurological symptoms related to the underlying disease: Parkinson's syndrome, psychiatric and cognitive disorders, epilepsy or headache. The purpose of this article is to provide a diagnostic aid, in addition to clinical and biology, through the analysis of calcification topography and the study of different MRI sequences.
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Affiliation(s)
- E Auffray-Calvier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France.
| | - A Lintia-Gaultier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
| | - R Bourcier
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
| | - J Aguilar Garcia
- Service de neuroradiologie, hôpital René-et-Guillaume-Laënnec, boulevard Jacques-Monod, 44093 Saint-Herblain cedex 1, France
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Saade C, Najem E, Asmar K, Salman R, El Achkar B, Naffaa L. Intracranial calcifications on CT: an updated review. J Radiol Case Rep 2019; 13:1-18. [PMID: 31558966 DOI: 10.3941/jrcr.v13i8.3633] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Intracranial calcifications are frequently encountered in non-contrast computed tomography scan in both adult and pediatric age groups. They refer to calcifications within the brain parenchyma or vasculature and can be classified into several major categories: physiologic/age-related, dystrophic, congenital disorders/phakomatoses, infectious, vascular, neoplastic, metabolic/endocrine, inflammatory and toxic diseases. In this updated review, we present a wide spectrum of intracranial calcifications from both pediatric and adult populations focusing on their pattern, size and location.
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Affiliation(s)
- Charbel Saade
- Department of Medical Imaging Sciences, American University of Beirut Medical Center, Beirut, Lebanon
| | - Elie Najem
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Karl Asmar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rida Salman
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassam El Achkar
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Lena Naffaa
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
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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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Freitas ME, Ruiz-Lopez M, Dalmau J, Erro R, Privitera M, Andrade D, Fasano A. Seizures and movement disorders: phenomenology, diagnostic challenges and therapeutic approaches. J Neurol Neurosurg Psychiatry 2019; 90:920-928. [PMID: 30796133 DOI: 10.1136/jnnp-2018-320039] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Revised: 02/06/2019] [Accepted: 02/07/2019] [Indexed: 02/07/2023]
Abstract
Seizures and movement disorders (MDs) are distinct neurological conditions presenting with abnormal movements. Despite sharing an overlap in phenomenology, these movements have different origins. In order to explore the overlaps and the narrow boundaries between these two conditions, we performed a review of the literature to explore the risk of seizures in MDs. We discussed the mimics and chameleons including MDs that look like seizure (eg, paroxysmal dyskinesia, status dystonicus) and seizures that look like MDs (eg, epilepsia partialis continua, nocturnal frontal lobe epilepsy). Additionally, we examined the therapeutic challenges as well as the anatomical and chemical pathways relevant in the interplay between epilepsy and MDs. Finally, we proposed an algorithm to guide clinicians towards the final diagnosis of conditions characterised by the co-occurrence of MDs and seizures.
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Affiliation(s)
- Maria Eliza Freitas
- Medicine, McMaster University Division of Neurology, Hamilton, Ontario, Canada
| | - Marta Ruiz-Lopez
- Service of Neurology, Fundación Jimenez Diaz University Hospital, Madrid, Spain
| | - Josep Dalmau
- Department of Neurology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Roberto Erro
- Department of Medicine, Surgery and Dentistry 'Scuola Medica Salernitana', University of Salerno, UCL Institute of Neurology, Baronissi, Italy
| | - Michael Privitera
- Epilepsy Center, University of Cincinnati Gardner Neuroscience Institute, Cincinnati, Ohio, USA
| | | | - Alfonso Fasano
- Neurology, Krembil Brain Institute; Movement Disorders Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto, Ontario, Canada
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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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Abstract
RATIONALE Fahr's syndrome (FS) is a rare neurological and psychiatric disorder characterized by bilateral brain calcifications when a secondary cause of the calcification is found. PATIENT CONCERNS A 53-year-old female patient diagnosed with FS for laminectomy because of ossification of posterior longitudinal ligament. She had a history of generalized tonic-clonic (GTC) seizure and medication with anticonvulsant drugs. She had gait disturbance, spasticity, bradykinesia, and diffuse calcifications in the basal ganglia, thalamus, cerebellum, and cerebral hemispheres on the brain computed tomography. On the preoperative examination, the serum and ionized calcium (Ca) were decreased to 3.7 and 2.22 mg/dL. Hypomagnesemia is combined with hypocalcemia. Furthermore, the level of parathyroid hormone was decreased to 2.18 pg/mL. DIAGNOSES Due to the radiologic findings and laboratory test results, she was diagnosed with FS with primary hypoparathyroidism. INTERVENTIONS The Ca and magnesium (Mg) had been corrected before surgery but the electrolytes revealed low level at the intraoperative period. The 300 mg of calcium chloride was administered at 2 times and 1200 mg of it were infused for 1 hour during intraoperative periods. In addition, total 4 g of Mg sulfate intravenously administered. We used rocuronium as a neuromuscular block and checked neuromuscular function by train-of-four monitoring. OUTCOMES Residual neuromuscular blockade was reversed with pyridostigmine and her muscle power completely recovered. The patient was extubated successfully and no unpredictable events occurred. On the day following transfer, serum electrolytes remained low, and although Ca was continuously supplied, serum Ca did not recover to a normal level. The patient was medicated with anticonvulsant drugs but experienced GTC seizure 2 weeks after surgery. LESSONS We presume that the pathophysiology of FS was related to primary hypoparathyroidism and hypomagnesemia. FS raises concerns associated with neuromuscular problems, spasticity, and seizure, and concerns of hypotension, heart failure, cardiac arrhythmia, and cerebrovascular attack during perioperative periods, among anesthesiologists because of hypocalcemia and vessel calcification. During the perioperative period, Ca levels should be closely monitored, and titrated Ca replacement therapy is recommended. The simultaneous correction of hypomagnesemia is of considerable importance when correcting hypocalcemia.
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Scaletti T. Is This a Psychiatric Emergency or Something More? J Emerg Nurs 2018; 45:570-571. [PMID: 30342767 DOI: 10.1016/j.jen.2018.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2018] [Revised: 09/07/2018] [Accepted: 09/17/2018] [Indexed: 10/28/2022]
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Yadav A. Unusual cause of hypotension in a polytrauma victim: A case of fahr\'s syndrome. Indian J Crit Care Med 2018; 22:621-623. [PMID: 30186019 PMCID: PMC6108303 DOI: 10.4103/ijccm.ijccm_2_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Fahr’s Disease Presenting as Late-Onset Levodopa-Responsive Parkinsonism. Can J Neurol Sci 2017; 44:322-323. [DOI: 10.1017/cjn.2016.428] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Abstract
RATIONAL Cerebroretinal microangiopathy with calcifications and cysts (CRMCC) is believed to be an autosomal recessive genetic disease, with disorders in multisystem organs. Its characteristic neurological disorders manifested on neuroimaging are a triad of leukoencephalopathy, intracranial calcifications, and parenchymal cysts. In this paper, we report a CRMCC patient with multisystem involvement, focusing on the neuroimaging features, to get a better understanding of the rare disease and improve our diagnostic ability. PATIENT CONCERNS The 23-year-old female patient firstly presented with an adolescence onset of ophthalmological manifestations. Four years later, hematological and neurological disorders occurred, the latter of which demonstrated a relatively slow progression in the following 7 years preceding her presentation to our hospital. INTERVENTIONS During hospitalization, disorders involving digestive, cardiovascular and respiratory systems were also detected. In addition, a more comprehensive depiction of neurological disorders on neuroimaging was also obtained. DIAGNOSES On the basis of multiple system disorders and the detection of mutations in conserved telomere maintenance component 1(CTC1) gene, a diagnosis of CRMCC was made. OUTCOMES After supportive therapy during her 4-week hospitalization, the patient's general condition improved and was released from the hospital. LESSONS CRMCC could be primarily diagnosed with the aid of its multiple system disorders and remarkable neuroimaging features. Cerebral micro hemorrhages determined by the combination of CT and T2-weighted magnetic resonance images in our case could provide some additional information for diagnosis. Furthermore, several other associated disorders were depicted for the first time in our case, expanding the clinical spectrum of CRMCC.
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Affiliation(s)
| | | | - Yicheng Zhu
- Department of Neurology, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences (PUMC&CAMS), Beijing, People's Republic of China
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