From the Guidelines
Basal ganglia calcifications should be managed by treating the underlying cause and addressing symptoms to improve quality of life, as the calcifications themselves cannot be removed. When considering the management of basal ganglia calcifications, it is crucial to identify the underlying cause, as this will guide the treatment approach 1. The causes of basal ganglia calcifications can be diverse, including idiopathic basal ganglial calcification, hypoparathyroidism, pseudo-parathyroidism, and other metabolic abnormalities 1. In some cases, basal ganglia calcifications may be associated with secondary paroxysmal kinesigenic dyskinesia (PKD), a condition characterized by sudden, brief, and recurrent episodes of involuntary movements 1. Key points to consider in the management of basal ganglia calcifications include:
- Identifying and treating the underlying cause, such as correcting calcium/phosphorus imbalances or managing parathyroid disorders 1
- Addressing symptoms, such as movement disorders, cognitive impairment, psychiatric symptoms, or seizures, with targeted medications or therapies 1
- Regular follow-up with neuroimaging and clinical assessment to monitor the progression of calcifications and adjust treatment as needed 1
- Considering genetic counseling for familial cases 1 Ultimately, the goal of management is to improve quality of life by alleviating symptoms and addressing the underlying cause of basal ganglia calcifications.
From the Research
Basal Ganglia Calcifications
- Basal ganglia calcifications can be physiological or pathological, with physiological calcifications occurring in about 0.3-1.5% of cases and being asymptomatic 2.
- Pathological basal ganglia calcification can be due to various causes, including metabolic disorders, infectious and genetic diseases 2, 3.
- The frequency of basal ganglia calcifications increases with age, particularly after 50 years old, and can be accompanied by neurological symptoms such as Parkinson's syndrome, psychiatric and cognitive disorders, epilepsy, or headache 3.
Causes of Basal Ganglia Calcifications
- Hypoparathyroidism and pseudohypoparathyroidism are common causes of pathological basal ganglia calcification, presenting with symptoms such as tetany, seizures, parkinsonism, and dementia 2.
- Infections such as toxoplasmosis, rubella, cytomegalovirus, cysticercosis, and AIDS can cause multiple and asymmetric intracranial calcifications 2, 4.
- Inherited and neurodegenerative diseases, such as Cockayne syndrome, tuberous sclerosis, Fahr's syndrome, and Down syndrome, can cause symmetrical, bilateral basal ganglia calcification 2, 5, 6.
Diagnosis and Management
- Basal ganglia calcifications can be detected incidentally by neuroimaging, and diagnosis involves analyzing calcification topography and studying different MRI sequences 3.
- Serum concentration of calcium, phosphorus, and parathyroid hormone should be determined in all individuals with calcification of the basal ganglia to rule out hypoparathyroidism 2.
- Treatment of underlying conditions, such as hypoparathyroidism, may lead to marked clinical improvement, and management of basal ganglia calcifications involves addressing the underlying cause 2, 5, 6.