Basal Ganglia Calcification



Basal Ganglia Calcification


Karen L. Salzman, MD



DIFFERENTIAL DIAGNOSIS


Common



  • Aging Brain, Normal


  • Neurocysticercosis


Less Common



  • Fahr Disease


  • Hypoxic-Ischemic Injury, NOS


  • MELAS


  • Congenital Infections



    • HIV, Congenital


    • CMV, Congenital


  • Endocrinologic Disorders



    • Hyperparathyroidism


    • Hypoparathyroidism


    • Pseudohypoparathyroidism


    • Pseudopseudohypoparathyroidism


    • Hypothyroidism


  • Toxoplasmosis, Acquired


  • Leigh Syndrome


  • Tuberculosis


  • Radiation and Chemotherapy


  • Cavernous Malformation (Mimic)


  • Vascular Calcification (Mimic)


  • Tuberous Sclerosis Complex (Mimic)


Rare but Important



  • Hallervorden-Spatz Syndrome


  • CO Poisoning


  • Parasites, Miscellaneous


ESSENTIAL INFORMATION


Key Differential Diagnosis Issues



  • Basal ganglia (BG) Ca++ is end result of multiple toxic, metabolic, inflammatory, and infectious insults


  • Location of Ca++ helpful to determine underlying cause (globus pallidus [GP] vs. putamen vs. caudate)


  • Patient age may impact differential diagnosis


Helpful Clues for Common Diagnoses



  • Aging Brain, Normal



    • Commonly affects GP more than putamen


    • Seen in aging brain as normal variant


    • Typically in patients older than 30 years


    • If occurs with other Ca++, consider pathologic condition


  • Neurocysticercosis



    • May occur anywhere in brain



      • Convexity subarachnoid spaces most common


    • Imaging varies with pathologic stage



      • Ca++ in nodular calcified (healed) stage


Helpful Clues for Less Common Diagnoses



  • Fahr Disease



    • Bilateral symmetric BG Ca++, often with Ca++ in other locations


    • GP is most common site of Ca++ (lateral > medial)


    • Other locations: Putamen, caudate, thalami, dentate nuclei of cerebellum, cerebral white matter, internal capsule


    • Associated abnormalities: Parkinsonism in autosomal dominant FD


  • Hypoxic-Ischemic Injury, NOS



    • HIE, term: Profound acute injury results in decreased BG and thalamic density, ± hemorrhage acutely



      • Lateral thalami and posterior putamen typical


      • May show Ca++ in chronic phase


    • HIE in adults: Putamen > GP typically



      • May have history of “anoxic event”


      • MR > CT for acute changes


      • May show Ca++ in chronic phase


  • MELAS



    • BG Ca++ in child or young adult with cortical lesions (parietooccipital > temporoparietal)


  • HIV, Congenital



    • Symmetric BG Ca++ and cerebral atrophy



      • GP and putamen > caudate


    • Subcortical WM Ca++ common


    • Ca++ occur in a fairly symmetric fashion a result of a calcific vasculopathy of medium and small arteries


  • CMV, Congenital



    • Periventricular Ca++, microcephaly, and cortical dysplasia characteristic


    • Periventricular > > BG Ca++


  • Endocrinologic Disorders



    • Bilateral BG: GP and putamen, dentate nuclei, thalami, subcortical areas


    • Ca++ in primary hypoparathyroidism is more diffuse than in other etiologies of Ca++


  • Toxoplasmosis, Acquired



    • Typically multifocal, but BG common site (up to 75%)


    • Enhancing lesion most common acutely



    • Post-therapy, Ca++ is common


  • Leigh Syndrome

Tags:
Aug 7, 2016 | Posted by in NEUROLOGY | Comments Off on Basal Ganglia Calcification

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