Calcification of the basal ganglia as a cause of levodopa‐resistant parkinsonism

Abstract

We present a patient with levodopa-resistant parkinsonism due to basal ganglia calcification related to surgically-induced hypoparathyroidism. The calcification was seen on computerized axial tomography but not on skull x-rays. Such calcification should be looked for in all cases of levodopa-resistant parkinsonism, since it is possible that treatment of hypoparathyroidism may halt progression of the disease. This case with similar ones from the literature suggest that striatal disease itself can cause parkingonism and that the parkinsonism in such patients tends to be less responsive or nonresponsive to levodopa.

Clinical Reasoning: A 57-year-old man with subacute gait difficulty and hand tremor

“…6 The parkinsonism secondary to striatal calcification is usually nonresponsive to levodopa treatment. 7 The mechanism of parkinsonism in HP is also not clear. The parkinsonism in HP occurs regardless of intracranial calcifications, hypocalcemia, or basal ganglia ischemia (thought to be due to vascular calcification) but improves with calcium supplementation in those with hypocalcemia.…”

Clinical Manifestations of Hypoparathyroidism

“…The most commonly reported manifestation is that of Parkinsonism (bradykinesia, mask-like facies, resting tremor, and shuffling gate). [19][20][21][22][23] Other extrapyramidal symptoms including choreiform movements and hemiballismus have also been described. [24][25][26][27] More rarely, cerebellar signs such as ataxia and dysarthria are seen in conjunction with hypoparathyroidism.…”

Hyperparathyroidism Associated with Parkinsonism.

“…To the contrary, extrapyramidal motor manifestations in hypoparathyroidism are not uncommon (6)(7)(8)(9)(10). Extrapyramidal movement disorders are present in patients with basal ganglia calcification which can be related to hypoparathyroidism (6)(7)(8) or rarely, to hyper parathyroidism (4,15).…”