A Unique Presentation of Fahr's Syndrome Secondary to Hypoparathyroidism.

Zaraq Rashid Khan,Waqar Waheed,Asim Ali,Gulalai Burki,Jawad Mabood

doi:10.7759/cureus.16063

Abstract

Fahr's syndrome is a rare condition characterized by deposition of bilateral symmetric calcium deposits in the basal ganglia and cerebellar region, leading to neurological and psychiatric sequelae. Herein we describe a case of a 62-year-old female presented with aphasia, bilateral lower limb rigidity, tremors, and gait disturbance. Her past medical history included thyroidectomy and radiation therapy 10 years back due to papillary carcinoma of the thyroid gland. On examination, she had poor speech, resting tremor, walking difficulty, and decreased power in all limbs with rigidity. Her Chvostek and Trousseau signs were positive. Serum investigations revealed hypocalcemia and low levels of parathyroid hormone and thyroid-stimulating hormone. Brain magnetic resonance imaging revealed calcified lesions in basal ganglia, thalami, and dentate nuclei. She was diagnosed with Fahr's syndrome due to hypoparathyroidism, and she was managed with calcium gluconate, vitamin D, salt-free albumin, and levodopa-carbidopa, improving her condition. The patient was then discharged on calcium gluconate, calcitriol, recombinant parathyroid hormone, and levodopa-carbidopa with follow-up.

Highlights

Fahr’s syndrome is characterized by the deposition of bilateral symmetric calcium deposits in the brain, more commonly in the basal ganglia and cerebellar region, leading to neurological and psychiatric sequelae [1]
Fahr's syndrome is a rare condition characterized by deposition of bilateral symmetric calcium deposits in the basal ganglia and cerebellar region, leading to neurological and psychiatric sequelae
Brain magnetic resonance imaging revealed calcified lesions in basal ganglia, thalami, and dentate nuclei. She was diagnosed with Fahr's syndrome due to hypoparathyroidism, and she was managed with calcium gluconate, vitamin D, salt-free albumin, and levodopa-carbidopa, improving her condition

Summary

Introduction

Fahr’s syndrome is characterized by the deposition of bilateral symmetric calcium deposits in the brain, more commonly in the basal ganglia and cerebellar region, leading to neurological and psychiatric sequelae [1]. A 62-year-old female was brought to the emergency department for complaints of aphasia, anorexia, and bilateral lower limb rigidity for the last month She had tremors in both hands and gait disturbance. Her blood pressure was 110/80 mmHg, respiratory rate 21/minute, heart rate 79/minute, and oxygen saturation 96% On neurological exam, she had an altered level of consciousness, poor speech following simple commands, and mild resting tremor in both hands without myoclonus. Tumor markers, and antinuclear antibody spectrum were within normal limits She was diagnosed with Fahr's syndrome due to secondary hypoparathyroidism. She was started on levodopa-carbidopa combination based on the high suspicion she might have developed Parkinson's disease-like symptoms secondary to Fahr's syndrome. The patient was discharged on calcium gluconate, calcitriol, recombinant parathyroid hormone, and levodopa-carbidopa with follow-up

Discussion

Conclusions

Disclosures