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Parathyroid hormone (PTH) has direct and indirect actions on cardiovascular cells. The effects of chronic hypoparathyroidism on cardiac morphology, function, and conduction are still unclear. Low PTH states are associated with multiple manifestations in the heart, acute or chronic. Acute hypocalcemic cardiomyopathy is a transient dilated cardiomyopathy with reduced ejection fraction and diffuse left ventricular hypokinesia. Chronic hypoparathyroidism-associated cardiomyopathy is a rare disease that may cause reduced myocardial tension, cardiac cavity enlargement, arrhythmias, and congestive heart failure. Here, we describe a 73-year-old woman with chronic hypoparathyroidism and hypocalcemia, who developed a hypertrophic cardiomyopathy, and not a dilated hypocalcemia-associated cardiomyopathy, which would be usually the case.
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Bilateral symmetric striatopallidal calcinosis with or without deposits in dentate nucleus, thalamus, and white matter is reported in patients ranging from asymptomatic, metabolic, toxic, and genetic autosomal dominant, familial or sporadic forms. Of the connective tissue diseases, it has been reported in very few cases in patients with systemic lupus erythematosus, many incorrectly labeled as Fahr syndrome without even having hypoparathyroidism. Here we describe a 30-year-old female patient with neuropsychiatric systemic lupus erythematosus manifested at diagnosis with mood disorders and anxiety, and 1-year later develops Lupus headache; Incidentally, an aneurism of the right middle cerebral artery and bilateral and symmetric calcifications of the caudate and lenticular nuclei were noted; this finding is a rarely reported manifestation of neuropsychiatric systemic lupus erythematosus. A review of the literature based on this case was carried out in electronic databases. There are approximately 29 patients reported in the literature, with calcifications in the basal ganglia associated with systemic lupus erythematosus occurs almost exclusively in young women (96.5%) with a mean age of 33.36 years (2 months-76 years), with a race predilection for Asians (65.5%). Regarding the neuropsychiatric syndromes defined by the American College of Rheumatology, the most frequently associated are movement disorders; followed by cognitive dysfunction, seizure disorders, mood disorders, cerebrovascular disease, psychosis, and acute confusional state, transverse myelitis, and demyelinating syndrome. The mean duration time of the SLE to detection of the basal ganglia calcification is 7.62 years (3 days-31 years).
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Introduction: Symmetric, bilateral basal ganglia calcification is rare finding that sometimes occurs asymptomatically. Its prevalence increases with age, and the most affected site is the globus pallidus. Report of cases: A series of seven cases with clinical and imaging diagnosis of basal ganglia calcification, recorded during the 2012 to 2016 period at the Department of Internal Medicine of the Hospital Civil de Guadalajara "Fray Antonio Alcalde, is presented. Most common clinical presentation was with altered alertness, headache and seizures. There was one case with movement disorders; there were no cases identified with dementia or tetany. Conclusion: Ganglia calcification can be associated with age-related neurodegenerative changes, but it can be an initial manifestation of a variety of systemic pathologies, including disorders of the calcium metabolism, intoxication by different agents, and autoimmune and genetic diseases. Correlation of typical imaging findings with clinical manifestations and laboratory results should be established to reach a definitive judgment.
Introducción: La calcificación bilateral y simétrica de los ganglios basales es un hallazgo infrecuente que a veces no ocasiona síntomas. Su prevalencia aumenta con la edad y el sitio más afectado es el globo pálido. Reporte de casos: Se describe una serie de siete casos con diagnóstico clínico y por imagen de calcificación de ganglios basales, atendidos entre 2012 y 2016 en el Servicio de Medicina Interna del Hospital Civil de Guadalajara Fray Antonio Alcalde. Las manifestaciones clínicas más comunes fueron alteración del estado de alerta, cefalea y crisis convulsivas. Se identificó un caso con trastornos del movimiento; no hubo casos con demencia o tetania. Conclusión: La calcificación de los ganglios puede estar relacionada con cambios neurodegenerativos por la edad, pero puede ser la manifestación inicial de una variedad de patologías sistémicas, incluyendo trastornos del metabolismo del calcio, intoxicación por diversos agentes, enfermedades autoinmunes y genéticas. Se debe hacer la correlación de los hallazgos de imagen típicos con manifestaciones clínicas y resultados de laboratorio para llegar a un dictamen definitivo.
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Doenças dos Gânglios da Base/diagnóstico , Calcinose/diagnóstico , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto JovemRESUMO
La enfermedad de Fahr es una entidad neurodegenerativa autosómica dominante poco frecuente, con incidencia en personas entre la cuarta y la quinta década de la vida, caracterizada por calcificaciones simétricas prominentes detectadas por tomografía computarizada en tálamo, cápsula interna, sustancia blanca, cerebelo y ganglios basales con o sin compromiso del núcleo dentado, sin que se relacione con alteraciones del metabolismo del calcio. Estos cambios pueden llevar a trastornos neuropsiquiátricos y síntomas piramidales, extrapiramidales y cerebelosos. En este artículo se exponen las manifestaciones clínicas, los hallazgos imaginológicos y la serología utilizada para llegar al diagnóstico de esta enfermedad con base en dos casos clínicos de la Clínica Universitaria Colombia en la ciudad de Bogotá.
Fahr's disease is an autosomal dominant neurodegenerative disease. It is infrequent, and it has an incidence between the fourth and fifth decade of life. It is characterized by prominent symmetrical calcifications detected in CT studies located on thalamus, internal capsule, white matter, cerebellum and basal ganglia with or without involvement of the dentate nucleus, without being related to calcium metabolism disorders. These changes may lead to neuropsychiatric disorders and pyramidal, extrapyramidal and cerebellar symptoms. In this article we expose the clinical manifestations, imaging findings and serology test used for the diagnosis of the disease based on two clinical cases in the Clínica Universitaria Colombia in Bogotá.
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Humanos , Calcinose , Tomografia Computadorizada por Raios X , Doenças NeurodegenerativasRESUMO
Brain calcifications may be present in a wide range of neuropsychiatric, infectious traumatic, neoplastic and endocrine conditions, associated with motor and cognitive symptoms. They are often considered "physiologic" or pathologic. OBJECTIVE: To determine the prevalence of brain calcifications in a Brazilian cohort. METHODS: 1898 consecutive patients underwent skull CTs, comprising 836 men and 1062 women. RESULTS: Among all 1898 patients, 333 (197 women and 136 men) presented with brain calcifications, representing an overall prevalence of 17.54%. The prevalence in the female group was 18.54% versus 16.26% in the male group. CONCLUSIONS: A growth in incidental findings on CT scans are likely as these exams become more widely available. However, a current debate between radiologists and regulators is set to redefine the CT usage, especially in the United States and the United Kingdom, considering new norms for use and radiation dosage per exam.
Calcificações cerebrais podem estar presentes em uma grande variedade de condições médicas, incluindo doenças infecciosas, endocrinológicas, traumáticas, neoplásicas, psiquiátricas e neurológicas, associados a diferentes manifestações clínicas. Elas são muitas vezes consideradas "fisiológicas" ou patológicas. OBJETIVO: Determinar a prevalência de calcificações cerebrais em uma coorte brasileira. MÉTODOS: 1898 pacientes consecutivos realizaram tomografia de crânio simples. 836 eram homens e 1062 eram mulheres. RESULTADOS: Entre todos os 1.898 pacientes, 333 (197 mulheres e 136 homens) apresentaram calcificações cerebrais. Assim, a prevalência total foi de 17,54%. No grupo feminino a prevalência foi de 18,54% e nos homens, 16,26%. CONCLUSÕES: Provavelmente os achados incidentais em tomografias computadorizadas (TC) serão crescentes, uma vez que estes exames estão mais disponíveis. No entanto, um debate atual entre radiologistas provavelmente deverá redefinir o uso de TC muito em breve, especialmente nos Estados Unidos e Reino Unido.
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Humanos , Calcinose , Cérebro , NeuroimagemRESUMO
Brain calcifications may be present in a wide range of neuropsychiatric, infectious traumatic, neoplastic and endocrine conditions, associated with motor and cognitive symptoms. They are often considered "physiologic" or pathologic. OBJECTIVE: To determine the prevalence of brain calcifications in a Brazilian cohort. METHODS: 1898 consecutive patients underwent skull CTs, comprising 836 men and 1062 women. RESULTS: Among all 1898 patients, 333 (197 women and 136 men) presented with brain calcifications, representing an overall prevalence of 17.54%. The prevalence in the female group was 18.54% versus 16.26% in the male group. CONCLUSIONS: A growth in incidental findings on CT scans are likely as these exams become more widely available. However, a current debate between radiologists and regulators is set to redefine the CT usage, especially in the United States and the United Kingdom, considering new norms for use and radiation dosage per exam.
Calcificações cerebrais podem estar presentes em uma grande variedade de condições médicas, incluindo doenças infecciosas, endocrinológicas, traumáticas, neoplásicas, psiquiátricas e neurológicas, associados a diferentes manifestações clínicas. Elas são muitas vezes consideradas "fisiológicas" ou patológicas. OBJETIVO: Determinar a prevalência de calcificações cerebrais em uma coorte brasileira. MÉTODOS: 1898 pacientes consecutivos realizaram tomografia de crânio simples. 836 eram homens e 1062 eram mulheres. RESULTADOS: Entre todos os 1.898 pacientes, 333 (197 mulheres e 136 homens) apresentaram calcificações cerebrais. Assim, a prevalência total foi de 17,54%. No grupo feminino a prevalência foi de 18,54% e nos homens, 16,26%. CONCLUSÕES: Provavelmente os achados incidentais em tomografias computadorizadas (TC) serão crescentes, uma vez que estes exames estão mais disponíveis. No entanto, um debate atual entre radiologistas provavelmente deverá redefinir o uso de TC muito em breve, especialmente nos Estados Unidos e Reino Unido.
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OBJECTIVES: Discuss pathophysiological aspects of cerebral calcifications (CC) and highlight its importance related to the occurrence of neuropsychiatric syndromes. METHOD: Single case report. RESULT: Man 52 years old, 20 years after going through a total thyroidectomy, starts showing behavioral disturbance (psychotic syndrome). He was diagnosed as schizophrenic (paranoid subtype) and submitted to outpatient psychiatric treatment. During a psychiatric admission to evaluate his progressive cognitive and motor deterioration, we identified a dementia syndrome and extensive cerebral calcifications, derived from iatrogenic hypoparathyroidism. CONCLUSION: The calcium and phosphorus disturbances, including hypoparathyroidism, are common causes of CC. Its symptoms can imitate psychiatric disorders and produce serious and permanent cognitive sequelae. The exclusion of organicity is mandatory in any psychiatric investigative diagnosis in order to avoid unfavorable outcomes, such as in the present case report.
OBJETIVOS: Discutir aspectos fisiopatológicos das calcificações cerebrais (CC) e ressaltar sua importância na ocorrência de síndromes neuropsiquiátricas. MÉTODO: Relato de caso individual. RESULTADO: Homem 52 anos de idade, 20 anos após tireoidectomia total, iniciou com alteração comportamental (síndrome psicótica), foi diagnosticado como portador de esquizofrenia paranoide e encaminhado para ambulatório de psiquiatria. Durante internação psiquiátrica, para avaliação de importante deterioração cognitivo e motora, foi verificada a vigência de síndrome demencial e extensas CC, secundários a hipoparatiroidismo iatrogênico. CONCLUSÃO: Os distúrbios do metabolismo do cálcio e do fósforo, incluindo o hipoparatiroidismo, são causas frequentes de CC. Seus sintomas podem mimetizar transtornos psiquiátricos e provocar sequelas cognitivas permanentes. A exclusão de organicidade é mandatória durante toda investigação diagnóstica na psiquiatria, a fim de evitar desfechos desfavoráveis, como no presente relato de caso.