A 57-year-old woman with seizures and coma

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Presentation transcript:

A 57-year-old woman with seizures and coma Teaching NeuroImages Neurology Resident and Fellow Section © 2017 American Academy of Neurology

Vignette A 57-year-old woman with a remote history of thyroidectomy but no prior neurologic symptoms developed seizures, fever, and coma Limited evaluation at her local hospital in rural Haiti demonstrated serum hypocalcemia (4 mg/dl) and the CT findings on the following slide Dade et al. © 2017 American Academy of Neurology

Imaging Axial (A-C) and sagittal (D) noncontrast head CT demonstrating extensive symmetric bilateral calcifications in the subcortical white matter, basal ganglia, thalami, and dentate nuclei. Dade et al. © 2017 American Academy of Neurology

Fahr Syndrome Caused by Hypoparathyroidism This pattern of calcification can occur in: Inherited conditions such as familial idiopathic basal ganglia calcification (Fahr disease) Acquired conditions (referred to as Fahr syndrome) including parathyroid dysfunction and intrauterine infection. 1,2 Given our patient’s severe hypocalcemia, Fahr syndrome was attributed to presumed hypoparathyroidism related to prior thyroidectomy in her case. References: 1. Saleem S, Aslam HM, Anwar M, et al. Fahr’s syndrome: literature review of current evidence. Orphanet J Rare Dis. 2013;8:156. 2. Perugula ML, Lippmann S. Fahr’s Disease or Fahr’s Syndrome? Innov Clin Neurosci. 2016;13:45-6. Dade et al. © 2017 American Academy of Neurology