Presentation
We present a case of a 55-year-old male who presented with the psychotic feature, bilateral tremors of hand and bilateral symmetrical calcification of basal ganglia. [ijpm.info]
New bulleted "Key Points" summaries present crucial information at a glance. A new two-color interior design greatly enhances the readability of differential diagnosis and treatment algorithms. [books.google.com]
The classic presentation of the disease, with its onset in the fourth decade of life and predominant neurological symptoms, should not be confused with a first break of schizophrenia. [checkorphan.org]
Patients 1 and 5 presented with unilateral symptoms. Considering that calcifications are bilateral, they should generally present with symmetrical symptoms and signs. [nature.com]
Defects in the calcium-sensing receptor gene: Presents as hypocalcaemia, inappropriately normal levels of PTH and raised phosphate levels. This is not true hypoparathyroidism but its presentation mimics it. Can present from birth to adulthood. [patient.info]
Entire Body System
- Short Stature
Diseases related with Short stature and Abnormality of extrapyramidal motor function In the following list you will find some of the most common rare diseases related to Short stature and Abnormality of extrapyramidal motor function that can help you [mendelian.co]
[…] calcifications in the cerebellar dentate nucleus ; Dolichocephaly ; Dysarthria ; Global developmental delay ; Infantile onset ; Intellectual disability, progressive ; Intellectual disability, severe ; Limb joint contracture ; Microcephaly ; Seizures ; Short [mousephenotype.org]
stature Decreased body height Small stature [ more ] 0004322 Spasticity Involuntary muscle stiffness, contraction, or spasm 0001257 Tetraplegia Paralysis of all four limbs 0002445 Showing of 19 | Last updated: 5/1/2019 If you need medical advice, you [rarediseases.info.nih.gov]
Short stature. Round face. Short neck. Shortening of the metacarpals and metatarsals. Hypothyroidism. Diabetes mellitus. Gonadal dysgenesis. [patient.info]
In addition to PHP, patients may have other manifestations of Albright's hereditary osteodystrophy (short stature, round facies, obesity, soft tissue calcification, and short metacarpals or metatarsals) [ Aurbach et al 1971 ]. [canglish1.tripod.com]
- Pallor
[…] reflex Visual loss Limb ataxia Limb dysmetria Impaired distal vibration sensation Jerky ocular pursuit movements Upgaze palsy Impaired visuospatial constructive cognition Urinary urgency Myopathy Impaired vibratory sensation Cardiomyopathy Optic disc pallor [mendelian.co]
Gastrointestinal
- Vomiting
He was brought into the triage because of severe headache associated with multiple episodes of vomiting. On examination, his vitals were stable and neurological examination was unremarkable except for mild disorientation. [omicsonline.org]
The patient did not report nausea, vomiting, headache, or pain from the lesion. On his admission, physical examination revealed a fluctuant mass approximately 3 cm in diameter. Very soft thrill and bruit were noted on the surface of the mass. [ajnr.org]
X-linked recessive inheritance Aggressive behavior Behavioral abnormality Abnormality of metabolism/homeostasis Pes cavus Attention deficit hyperactivity disorder Rigidity Hyperactivity Absent speech Self-mutilation Clinodactyly of the 5th finger Clonus Vomiting [mendelian.co]
- Nausea
The patient did not report nausea, vomiting, headache, or pain from the lesion. On his admission, physical examination revealed a fluctuant mass approximately 3 cm in diameter. Very soft thrill and bruit were noted on the surface of the mass. [ajnr.org]
Cardiovascular
- Cyanosis
Symptoms usually develop during the 1st month after birth and may include cyanosis,jaundice,fever,respi-ratory distress, or meningoencephalitis manifesting with lethargy, fever, and seizures (Noorbehesht et al. 1987). [rrnursingschool.biz]
Eyes
- Kayser-Fleischer Ring
[…] may be dominant or recessive Pantothenate kinase-associated neurodegenerationAbnormal iron accumulation; “eye of the tiger” sign on magnetic resonance imaging; 50% cases from PANK2 mutations Wilson diseaseAbnormal copper metabolism; liver toxicity; Kayser–Fleischer [clinchem.aaccjnls.org]
Musculoskeletal
- Macrocephaly
Bilamellar calcification of the falx cerebri is a major diagnostic criterion, whereas macrocephaly and frontal bossing are minor diagnostic criteria (Kimonis et al. 1997). [rrnursingschool.biz]
Skin
- Dry Hair
Dry hair and skin. Painful menstruation. Important points to elicit in the history include: History of previous neck surgery. Family history of any hypoparathyroid disorders. [patient.info]
Additional systemic features include cataracts, dry hair, alopecia, dental dysplasia, caries, and predisposition to moniliasis. [canglish1.tripod.com]
Face, Head & Neck
- Round Face
Round face. Short neck. Shortening of the metacarpals and metatarsals. Hypothyroidism. Diabetes mellitus. Gonadal dysgenesis. As part of an autoimmune process: [ 3 ] Autoimmune polyglandular syndrome type 1 (APS-1): autosomal recessive inheritance. [patient.info]
Urogenital
- Incontinence
Frequent falls Intention tremor Falls Abnormality of the cerebral white matter Milia Spastic gait Autosomal dominant inheritance Cerebral palsy Tics Intellectual disability, moderate Tetraparesis Spastic tetraparesis Aspiration Difficulty walking Urinary incontinence [mendelian.co]
Urinary urgency or incontinence and impotence may be present [ Manyam et al 1992, Tokoro et al 1993 ]. [canglish1.tripod.com]
Oxybutynin is used for urinary incontinence and antiepileptics are used for seizures [ 17 ]. [ojrd.biomedcentral.com]
Neurologic
- Cerebral Calcification
The possible relationship between cerebral calcification and anomalous intracranial venous drainage is discussed. [ajnr.org]
[…] basal ganglia calcification Basal Ganglia Calcification, Idiopathic, 3 IBGC1 BASAL GANGLIA CALCIFICATION, IDIOPATHIC, 1; IBGC1 Striopallidodentate Calcinosis, Bilateral Striopallidodentate Calcinosis, Autosomal Dominant, Adult-Onset Cerebral Calcification [wikidata.org]
Name Basal Ganglia Calcification, Idiopathic, Childhood-Onset Synonyms CEREBRAL CALCIFICATION, NONARTERIOSCLEROTIC, IDIOPATHIC, CHILDHOOD-ONSET, IBGC, CHILDHOOD-ONSET, STRIOPALLIDODENTATE CALCINOSIS, BILATERAL, CHILDHOOD-ONSET Classification genetic, [mousephenotype.org]
Synonyms Fahr disease/Cerebrovascular ferrocalcinosis/Idiopathic non arteriosclerotic cerebral calcifications /Bilateral strio pallidodentate calcinosis/ Idiopathic basal ganglia calcification Presentation It is a rare degenerative neurological disorder [ispub.com]
[…] brain, including cysticercosis cerebri, 22 hydatid disease, 23,24 and tuberculosis. 25 In hydatid disease, calcification of unilocular cerebral hydatid cysts occurs in fewer than 1% of cerebral hydatid cysts. [consultant360.com]
- Extrapyramidal Symptoms
Most common presentation are seizures, although rarely they present with extrapyramidal symptoms and neuropsychiatric signs. [omicsonline.org]
In a survey of 72 patients with intracranial calcifications, Kazis reported that extrapyramidal symptoms were present in 15(20.8%) patients, while in another study the frequency of extrapyramidal symptoms was calculated to be 56% [ 23, 25 ]. [ojrd.biomedcentral.com]
Motor, sensory, and gait examinations were normal, indicating no signs of extrapyramidal disease. [consultant360.com]
Neuroleptic medication should be used cautiously, since it may potentiate extrapyramidal symptoms [ Cummings et al 1983 ]. [canglish1.tripod.com]
- Gait Ataxia
[…] lower limb spasticity and weakness and prominent cerebellar ataxia, associated with gait disturbances, dysarthria, increased deep tendon reflexes and extensor plantar responses. [mendelian.co]
Affected individuals show a varied combination of gait ataxia, dysarthria, involuntary movements, seizures, psychosis, and dementia, overlapping with the clinical picture of families with FIBGC [ Farmer et al 1991 ]. [canglish1.tripod.com]
- Poor Coordination
Neurological presentations include movement disorders (tremors, poor coordination, loss of fine-motor control, chorea, choreoathetosis) or rigid dystonia (mask-like facies, rigidity, gait disturbance, pseudobulbar involvement). [canglish1.tripod.com]
- Tingling
Paraesthesiae (tingling, vibrating, burning and numbness) of the face, fingers and toes. Facial twitching. Carpopedal spasm. Stridor. Convulsions (usually grand mal). Syncope. Emotional lability, anxiety and depression, confusion. Memory impairment. [patient.info]
Workup
However, traditional one-by-one genetic testing facilitating the diagnostic workup is increasingly replaced by simultaneous gene testing using next-generation multiple gene panels and whole exome/genome sequencing. [movementdisorders.org]
While a full endocrine workup revealed no overt abnormalities, genetic analysis identified a previously reported mutation in the SLC20A2 gene (c.1753 G > A) 3. [nature.com]
Routine hematologic and biochemical investigations, as well as workup for metabolic, inflammatory, and infectious conditions, do not disclose specific abnormalities. [canglish1.tripod.com]
X-Ray
- Multiple Renal Cysts
Multiple renal cysts and renal cell carcinoma are uncommon, each occurring in about 2% of patients (Sampson et al. 1995). [rrnursingschool.biz]
Urine
- Acanthocytes
[…] mutations Wilson diseaseAbnormal copper metabolism; liver toxicity; Kayser–Fleischer rings; mutations in ATP7B Other hereditary disorders Mitochondrial disordersMultiple types; maternal inheritance NeuroacanthocytosisSeveral conditions characterized by acanthocytes [clinchem.aaccjnls.org]
The detection of acanthocytes often remains elusive, although the probability to detect the characteristic deformed erythrocytes can be increased by using a 1:1 dilution with physiological saline and phase contrast microscopy. [63] However, many hematology [movementdisorders.org]
Other Test Results
- Cortical Tubers
Typical brain lesions include sub-ependymal hamartomas (giant cell astrocytomas) and cortical tubers. These lesions are clearly depicted by MRI. [rrnursingschool.biz]
Tuberous sclerosis complex It is a disorder affecting multiple systems including abnormalities of skin (Hypermelanotic, Macules, Fascial Angiofibromas, Shagreen Patches, Fibrous Fascial Plaques, Ungual Fibroma), brain (Cortical Tubers, Subependymal Nodules [ojrd.biomedcentral.com]
Tuberous sclerosis, inherited in an autosomal dominant manner, involves abnormalites of the skin (hypomelanotic macules, facial angiofibromas, shagreen patches, fibrous facial plaques, ungual fibromas), brain (cortical tubers, subependymal nodules, seizures [canglish1.tripod.com]
Treatment
Thorough coverage for each neurological disease clearly defines age at onset, course of illness, clinical features, and treatment options. Differential diagnosis tables and treatment algorithms expedite clinical decision making. [books.google.com]
If your child has been diagnosed with basal ganglia calcification, talk with your pediatrician and specialists about the most current treatment options. [diseaseinfosearch.org]
Treatment was well-accepted by all patients, with no reported adverse effects. An initial concern was that, for unknown reasons, alendronate treatment could trigger new symptoms; this was not the case. [nature.com]
Radiation or drugs: Neck or chest irradiation during radiotherapy treatment. Radioactive iodine treatment for hyperthyroidism: a rare side-effect. Chemotherapeutic/cytotoxic agents. Alcohol. [patient.info]
You may also want to contact a university or tertiary medical center in your area, because these centers tend to see more complex cases and have the latest technology and treatments. [rarediseases.info.nih.gov]
Prognosis
Diagnosis - Idiopathic basal ganglia calcification- childhood onset Home medical testing related to Idiopathic basal ganglia calcification, childhood onset: Cold & Flu: Home Testing: Home Fever Tests Home Ear Infection Tests Home Flu Tests Prognosis - [checkorphan.org]
Prognosis There is no cure for Fahr’s Syndrome, nor is there a standard course of treatment. Treatment addresses symptoms on an individual basis. [wikidoc.org]
Treatment and Prognosis FS has no cure and does not have a standardized treatment regimen. Current therapies are mainly targeted towards the symptoms and complications associated with the condition. [news-medical.net]
Prognosis The regular monitoring required to ensure appropriate calcium levels means that the prognosis is challenging for many people. This may improve if synthetic PTH becomes widely available. [patient.info]
Case reports have suggested that haloperidol or lithium carbonate may help with psychotic symptoms. [22] One case report described an improvement with the use of a bisphosphonate. [23] Prognosis [ edit ] The prognosis for any individual with PFBC is variable [en.wikipedia.org]
Etiology
More extensive calcification and subarachnoid space dilatation correlate with the presence of psychiatric manifestations, but calcific distribution and etiology do not. [ijpm.info]
The etiology of our case patient’s calcification was idiopathic, so her treatment was mainly supportive. [consultant360.com]
The condition is predominantly found to be autosomal-dominant. [1] The etiology of Fahr's disease is very complex and still remains unknown. However, calcium deposits are the major elements responsible for the radiological appearance of the disease. [neurologyindia.com]
Ataxia, titubation, dysdiadochokinesia, loss of check and other cerebellar or brainstem signs “Milkmaid’s grip,” darting tongue, orofacial dyskinesia, hypotonia, pendular or “hung-up” reflexes, dementia in Huntington disease, carditis in Sydenham chorea Etiology [musculoskeletalkey.com]
All etiological factors were combined in Table 1 Table 1 Etiological manifestations of Fahr’s syndrome 1 Endocrine disorders Idiopathic hypoparathyrodism Secondary hypoparathyrodism, Pseudohypoparathyroidism Pseudo-pseudohypoparathyroidism Hyperparathyroidism [ojrd.biomedcentral.com]
Epidemiology
Epidemiology This is a rare disorder. Found equally in males and females. Age of onset depends on the aetiology. Aetiology Hypoparathyroidism may be transient, congenital/genetically inherited or acquired. [patient.info]
PubMed View Article Google Scholar Trenkwalder C, Schwarz J, Gebhard J, Ruland D, Trenkwalder P, Hense HW, Oertel WH: Starnberg trial on epidemiology of Parkinsonism and hypertension in the elderly. [ojrd.biomedcentral.com]
Pathophysiology
We reviewed the literature and discussed the pathophysiology, differential diagnosis and treatment of this disorder. [content.iospress.com]
Pathophysiology and Diagnostic Criteria for FS Heterogeneity in FS has been suggested due to three possible chromosomal loci being identified. [news-medical.net]
The molecular pathophysiology is not fully understood. [movementdisorders.org]
Insulin dysregulation and changes in insulin action have been of concern in the pathophysiology and clinical symptomatology of PD. [7] Therefore, we propose that for patients with Fahr's disease, genetic factors play a key role in the development of BGCs [neurologyindia.com]
The pathophysiological mechanisms leading to Bilateral Calcification. Only rare data are available on the early events leading to bilateral calcification. 2. The development of safe and effective medical treatments. [ojrd.biomedcentral.com]
Prevention
Prevention - Idiopathic basal ganglia calcification- childhood onset Not supplied. [checkorphan.org]
Finding these genes could lead to effective ways to treat and prevent Fahr’s Syndrome. Source This article is based on a Q&A website prepared by NINDS [1], part of the National Institutes of Health located in Bethesda, Maryland. [wikidoc.org]
Treatment is usually directed to this identifiable cause [ 10 ] and can prevent calcifications and neurophysiological disorders [ 3, 5 ]. [omicsonline.org]
M4 mentioned he ≪ recognized that his life was not only for himself ≫ and began to pay more attention to his health to prevent the disease progression, not only for himself but also for his wife. [springerplus.springeropen.com]
Prevention Close monitoring of patients undergoing thyroid or neck surgery, radiotherapy to the neck or chest and chemotherapy treatment for symptoms and signs of hypocalcaemia. [patient.info]