Extensive Intra-Cerebral Calcification and Uncontrolled Seizures due to Hypo-Parathyroidism

Abstract

Calcifications in brain parenchyma is a routine CT Scan curiosity.1,2,3,4 It can occur in several clinical conditions and hypoparathyroidism is one.4,5,6 We are reporting a case of hypoparathyroidism following total thyroidectomy manifesting as extensive intracerebral calcifications and uncontrolled seizures. The role of routine calcium estimation in seizure disorders is highlighted. A low Ca and high P in the absence of renal failure and massive tissue destruction invariably mean hypoparathyroidism. Selective involvement in Basal Ganglia and other areas are due to high neurotransmitter sensitivity and metabolic rate. Calcium is merely laid upon as fundamental organic matrix from mucopolysaccharides and glycoprotein. This type of calcification contains hydroxyapatite different from usual calcifications. DPH by their effect on Vit.D and calcium metabolism can aggravate hypocalcaemia and seizure; may impair 25-hydroxylation by inactivating microsomal enzymes in liver; have direct negative effect on intestinal calcium transport and bone metabolism. DPH and Pheno. may delay the diagnosis by suppressing the peripheral manifestations of neuromuscular irritability in hypo para-thyroidism. Sodium valproate is the preferred anti-convulsant.