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)

🧬 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

☣️ 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

🦠 Infectious Causes

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

🧠 Others

• Radiation therapy
• Chronic neuroinflammation

🧪 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