Radiology Case of the Month

A 39-year-old woman was referred to the Louisiana State University Health Sciences Center Neurology clinic for follow-up of abnormal imaging findings. One month prior, she had been in a motor vehicle collision where she briefly lost consciousness. She was taken by ambulance to the emergency department where she was assessed and subsequently cleared of injuries. Non-contrast head computed tomography (CT) showed large areas of bilateral calcification within the basal ganglia, cerebellum, and subcortical white matter (Figure 1). Her past medical history was positive for migraines for the past five years, photophobia for over ten years, anxiety, cervical cancer, and hysterectomy. Her family history included a sister with epilepsy, a father who died of stroke at age 52, and a paternal grandmother with Alzheimer’s dementia. Physical exam revealed an obese woman who was fully oriented with an appropriate affect. She scored a 28/30 on the Montreal Cognitive Assessment. She wore sunglasses during the visit due to light sensitivity. Cranial nerve examination was normal, including a normal fundoscopic examination. A mild action tremor was present in her hands. Her gait was normal but with an in-toed stance. Laboratory studies, including complete blood count, comprehensive metabolic panel, thyroid studies, intact parathyroid hormone levels, total and ionized calcium levels, serum lactate, antinuclear antibodies, and heavy metal screen, were within normal limits. Electroencephalogram (EEG) demonstrated normal awake and asleep patterns. The presumptive diagnosis of idiopathic basal ganglia calcification was made based on the extensive and strikingly characteristic bilateral calcifications seen on the CT.