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CC BY 4.0 · Arq Neuropsiquiatr 2024; 82(12): s00441788778
DOI: 10.1055/s-0044-1788778
Images in Neurology

Complex movement disorders in early onset hypoparathyroidism

Distúrbios do movimento complexos em hipoparatireoidismo de início precoce
Filipe Sarmento 
1   University of Florida, Norman Fixel Institute for Neurological Diseases, Gainesville FL, United States.
2   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
João Vitor Gerdulli Tamanini 
2   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Sofia Mônaco Gama 
2   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
Leonardo Furtado Freitas 
1   University of Florida, Norman Fixel Institute for Neurological Diseases, Gainesville FL, United States.
3   University of Iowa, Department of Radiology, Division on Neuroradiology, Iowa City IA, United States.
,
Orlando Graziani Povoas Barsottini 
2   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
,
José Luiz Pedroso 
2   Universidade Federal de São Paulo, Departamento de Neurologia e Neurocirurgia, São Paulo SP, Brazil.
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A 23-year-old female patient with long-standing untreated idiopathic hypoparathyroidism presented with complex involuntary movements. Physical examination revealed generalized dystonia, painful spasms, and stereotypies ([Video 1]). Brain magnetic resonance imaging ([Figure 1]) and brain CT ([Figure 2]) revealed extensive bilateral calcification.

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Figure 1 Brain MRI: A/D - T1 hyperintense signal in the basal ganglia and dentate nuclei; B/E - T2 low to isointense signal in the basal ganglia and dentate nuclei; C/F - SWI hyposignal in the basal ganglia, dentate nuclei and subcortical white matter.
Zoom Image
Figure 2 Brain CT scan disclosing bilateral and symmetrical calcification in the basal ganglia, thalamus, dentate nuclei, and subcortical white matter.

Video 1. Complex movement disorders in early onset hypoparathyroidism.


Quality:

Hypoparathyroidism can present with a variety of neurological symptoms ([Figure 3]), including, though less commonly, movement disorders such as chorea, parkinsonism, dystonia, choreoathetosis, and paroxysmal dyskinesia.[1] [2] Notably, stereotypic-like movements were only previously described by Galvez-Jimenez et al.[1] Central nervous system calcifications are present in up to 74% of patients with hypoparathyroidism.[3] Despite its prevalence, there is no clear relationship between the location and extent of the calcifications and the clinical phenotype.[3]

Zoom Image
Figure 3 The figure demonstrates the broad spectrum of neurological manifestations associated with hypoparathyroidism. Additionally, it depicts ion changes in the blood.

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Conflict of Interest

The authors have no conflict of interest to declare.

Authors' Contributions

FPS: conceptualization, data curation, project administration, supervision, writing – original draft, writing – review & editing; JVGT, SMG: writing – original draft, writing – review & editing; LFF: data curation, writing – review & editing; OGPB: supervision; JLP: conceptualization, data curation, project administration, supervision, writing – review & editing.


  • References

  • 1 Gálvez-Jiménez N, Hanson MR, Cabral J. Dopa-resistant parkinsonism, oculomotor disturbances, chorea, mirror movements, dyspraxia, and dementia: the expanding clinical spectrum of hypoparathyroidism. A case report. Mov Disord 2000; 15 (06) 1273-1276 . Doi: 10.1002/1531-8257(200011)15:6⟨1273::aid-mds1038⟩3.0.co;2-o
    CrossrefPubMedGoogle Scholar
  • 2 Manyam BV, Walters AS, Narla KR. Bilateral striopallidodentate calcinosis: clinical characteristics of patients seen in a registry. Mov Disord 2001; 16 (02) 258-264 DOI: 10.1002/mds.1049.
    CrossrefPubMedGoogle Scholar
  • 3 Mannstadt M, Bilezikian JP, Thakker RV. et al. Hypoparathyroidism. Nat Rev Dis Primers 2017; 3: 17080 DOI: 10.1038/nrdp.2017.55.
    CrossrefPubMedGoogle Scholar

Address for correspondence

Filipe Sarmento

Publication History

Received: 24 May 2024

Accepted: 29 June 2024

Article published online:
04 September 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution 4.0 International License, permitting copying and reproduction so long as the original work is given appropriate credit (https://creativecommons.org/licenses/by/4.0/)

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Bibliographical Record
Filipe Sarmento, João Vitor Gerdulli Tamanini, Sofia Mônaco Gama, Leonardo Furtado Freitas, Orlando Graziani Povoas Barsottini, José Luiz Pedroso. Complex movement disorders in early onset hypoparathyroidism. Arq Neuropsiquiatr 2024; 82: s00441788778.
DOI: 10.1055/s-0044-1788778

  • References

  • 1 Gálvez-Jiménez N, Hanson MR, Cabral J. Dopa-resistant parkinsonism, oculomotor disturbances, chorea, mirror movements, dyspraxia, and dementia: the expanding clinical spectrum of hypoparathyroidism. A case report. Mov Disord 2000; 15 (06) 1273-1276 . Doi: 10.1002/1531-8257(200011)15:6⟨1273::aid-mds1038⟩3.0.co;2-o
    CrossrefPubMedGoogle Scholar
  • 2 Manyam BV, Walters AS, Narla KR. Bilateral striopallidodentate calcinosis: clinical characteristics of patients seen in a registry. Mov Disord 2001; 16 (02) 258-264 DOI: 10.1002/mds.1049.
    CrossrefPubMedGoogle Scholar
  • 3 Mannstadt M, Bilezikian JP, Thakker RV. et al. Hypoparathyroidism. Nat Rev Dis Primers 2017; 3: 17080 DOI: 10.1038/nrdp.2017.55.
    CrossrefPubMedGoogle Scholar

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Zoom Image
Figure 1 Brain MRI: A/D - T1 hyperintense signal in the basal ganglia and dentate nuclei; B/E - T2 low to isointense signal in the basal ganglia and dentate nuclei; C/F - SWI hyposignal in the basal ganglia, dentate nuclei and subcortical white matter.
Zoom Image
Figure 2 Brain CT scan disclosing bilateral and symmetrical calcification in the basal ganglia, thalamus, dentate nuclei, and subcortical white matter.
Zoom Image
Figure 3 The figure demonstrates the broad spectrum of neurological manifestations associated with hypoparathyroidism. Additionally, it depicts ion changes in the blood.