Basal Ganglia Calcification Secondary to Postsurgical Hypoparathyroidism Presenting With Seizures and Acute Confusion: A Case Report (Fahr Syndrome)

TL;DR

A woman with postsurgical hypoparathyroidism developed Fahr syndrome, showing brain calcifications and neurological symptoms, which improved with calcium and vitamin D treatment.

Contribution

This case highlights Fahr syndrome as a rare complication of hypoparathyroidism and emphasizes the need for early metabolic correction.

Findings

The patient showed extensive symmetrical calcifications in the basal ganglia, thalamus, and subcortical regions.

Treatment with calcium and vitamin D led to gradual neurological improvement.

Basal ganglia calcifications in hypoparathyroidism are often incidental but can cause acute neurological symptoms.

Abstract

Fahr syndrome is a rare neurologic condition characterized by bilateral intracranial calcifications, most commonly associated with metabolic or endocrine disorders, particularly hypoparathyroidism. We report a middle-aged woman with post-surgical hypoparathyroidism who presented with acute confusion and a generalized tonic-clonic seizure. Laboratory evaluation revealed severe hypocalcemia with undetectable parathyroid hormone levels. Non-contrast computed tomography (CT) of the head demonstrated extensive, symmetrical calcifications predominantly involving the basal ganglia, with additional thalamic and scattered subcortical involvement, consistent with Fahr syndrome. The patient was treated with intravenous calcium followed by oral calcium and vitamin D supplementation, with gradual neurologic improvement. This case emphasizes that basal ganglia calcifications in hypoparathyroidism are often an incidental radiologic finding and underscores the importance of early, sustained metabolic correction to prevent recurrent hypocalcemic complications and potential clinical progression.

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