Extensive basal ganglia calcification

Case contributed by James Mirow

Presentation

Patient presented with no neurological signs, recently diagnosed hypercalcaemia. Referral for CT Brain ? basal ganglia calcification.

Patient Data

Age: 20 years
Gender: Male
CT

Non Contrast CT Brain

Extensive calcification involving caudate nuclei, putamen and thalamus bilaterally. Calcification involving subcortical grey matter in frontal and parietal lobes. The density measure of calcification was approximately 160 HU.

Case Discussion

Basal ganglia calcification is a rare finding on brain imaging, approximately seen in 1% of all CT brain scans. Rarer still is the finding of this pathology in a person of this age.

There are many differential diagnoses for this appearance, including Fahr syndrome, exposure to toxic chemicals and congenital infection, the latter needs to be strongly considered in this age group.

In this case, the patient was asymptomatic, with hypercalcemia being the only clinical indicator. In some cases, however, neurological symptoms can be evident and severe, including psychosis, cognitive impairment, dementia.

The DLP for this study was 821 mGy.cm which is below the current ARPANSA reference of 880mGy.cm which is excellent, especially considering patient age. The head is flexed maximally to eliminate direct orbit exposure as much as possible and axial plane reformats performed parallel to the pit fossa-occipital protuberance line (similar to the AC-PC line).

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Case information

rID: 65582
Published: 17th Jan 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included

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