Extensive Bilateral Cerebral Calcifications in a Patient With Primary Hypoparathyroidism

Intracranial physiological calcifications evaluated with cone beam CT

“…When they do occur, as a general guide pathological calcifications may appear larger than a few millimetres in size, or they may appear abnormal in shape and configuration or non-symmetrical compared with physiological calcifications with irregular borders, or they may be located at sites other than those previously described as common for physiological calcification. [2][3][4] In our study, the finding of small calcifications with well-defined borders, and symmetrical to the midline or bilateral, was highly indicative of a normal developmental or physiological process in these patients rather than representing pathological calcification; this along with the aforementioned factors should be kept in mind when trying to discriminate physiological from pathological calcifications in addition to any pertinent medical history or signs and symptoms clinically. Previous investigators have described pathological calcifications appearing on CT scans in significant detail for reference, but if questionable calcifications are discovered on CBCT scans by a non-radiologist practitioner, it may be prudent to seek the opinion of a maxillofacial radiologist for more accurate characterization and diagnosis, or for recommendation of additional imaging studies if warranted.…”

“…Conversely, pathological calcification in the brain has been described as a possible and extremely rare phenomenon in patients with (1) infectious diseases such as tuberculosis, toxoplasmosis or cysticercosis, (2) primary intracranial tumours or metastatic lesions, (3) autoimmune conditions such as lupus, (4) certain developmental disorders or syndromes, (5) endocrine disorders such as thyroid or parathyroid disease and (6) neuropsychiatric conditions associated with seizures or strokes. [2][3][4][5][6] Table 1 summarises the causes of intracranial calcifications.…”

Intracranial Calcifications in Autoimmune Polyendocrinopathy Candidiasis Ectodermal Dystrophy (APECED) Syndrome: A Case Report and Literature Review

“…They may extend to affect the cerebellum and subcortical white matter. 12,13 Although brainstem calcifications have been reported in hypoparathyroidism secondary to causes other than autoimmunity (e.g., familial idiopathic and postthyroidectomy hypoparathyroidism), 14,15 the involvement of the brainstem by such calcifications, however, was not reported in APECED patients. To the best of our knowledge, this is the first case of APECED syndrome with brainstem calcifications to be reported expanding the radiological phenotype of such a rare disorder.…”