Calcification of the basal ganglia

🔬 Metabolic and Endocrine Causes 1. Hypoparathyroidism – most common systemic cause • ↓ PTH → ↓ calcium, ↑ phosphate • Leads to symmetrical basal ganglia calcifications • May be idiopathic or post-surgical 2. Pseudohypoparathyroidism • PTH resistance; biochemical profile resembles hypoparathyroidism 3. Hyperparathyroidism • Less common, but can also lead to intracranial calcifications 4. Other metabolic disorders • Hypomagnesemia, hypophosphatasia, mitochondrial cytopathies (like MELAS)

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🧬 Genetic and Degenerative Disorders 1. Fahr’s Disease (Idiopathic Basal Ganglia Calcification) • Familial, autosomal dominant • Progressive neurologic symptoms (parkinsonism, dementia, seizures) • Normal calcium/phosphorus levels 2. Wilson’s Disease • Copper accumulation → may cause T2 hyperintensities or calcifications • Neurologic and hepatic involvement 3. Mitochondrial disorders • MELAS, Leigh syndrome • Often show basal ganglia abnormalities and calcifications

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☣️ Toxic/Environmental Causes 1. Lead poisoning • Chronic exposure may lead to calcifications and cognitive/behavioral changes 2. Carbon monoxide poisoning • Hypoxic damage → calcifications of globus pallidus over time

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🦠 Infectious Causes • Congenital infections (especially TORCH): • Toxoplasmosis, Cytomegalovirus (CMV) – classically cause periventricular or basal ganglia calcifications in neonates

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🧠 Others • Radiation therapy • Chronic neuroinflammation

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🧪 Workup Suggestion (in symptomatic or extensive cases) • Serum calcium, phosphate, PTH, magnesium • Vitamin D levels • Brain CT (best to detect calcifications) • Consider genetic testing if familial or Fahr’s suspected • Toxicology screen if exposure suspected