A 42-year-old-man had focal left hand motor seizures. MR studies demonstrated a right posterior frontal brain tumor. Functional MRI was performed, localizing the motor cortex posterior to the lesion. The functional images were integrated with a neurosurgical navigation computer. A real-time intraoperative display of the anatomic and functional images was produced, registered to a neurosurgical probe. Excellent correlation was demonstrated between the functional maps and invasive electrophysiologic mapping performed at the time of craniotomy.

Primary hyperparathyroidism is due to parathyroid adenoma (80-85%), hyperplasia (10-15%), carcinoma (2-3%) of cases. The most common presentation is asymptomatic hypercalcemia. Multiple pathological fractures, nephrocalcinosis as a presenting feature of primary hyperparathyroidism due to parathyroid adenoma is extremely rare at the age of 19 years. A case of parathyroid adenoma with multiple fractures of left femur, renal calculi, nephrocalcinosis, weight loss, constipation, dyspepsia abdominal pain was presented. The case was investigated completely with biochemical investigations, X-ray of forearm bones and femur, ultrasonography of neck and abdomen, CT scan of neck and abdomen, MRI scan, Scintigraphy of the neck. Right inferior parathyroid adenoma was diagnosed and confirmed by histopathological examination after excision. The post operative serum calcium levels became normal.Keywords Parathyroid adenoma Á Ultrasonography Á Scintigraphy Case ReportRohit 19 years old boy presented with supracondylar fracture of femur on trivial fall, abdominal pain, dyspepsia, pain during micturition. The previous history showed fracture neck of femur on trivial fall 2 months before. On examination showed swelling in the right lower lobe of thyroid region, moving with deglutition. Serum calcium (12.5 mg/dl), parathyroid hormone (817 pg/ml), urinary calcium (438 mg/24 h of urine) levels were elevated. X-ray of forearm bones showing lytic expansile lesion of right 5th metacarpal bone involving the metadiaphysial region with endosteal scalloping. Ultrasonography of neck shows solid cystic lesion inferior to right thyroid gland ( Fig. 1) with increased vascularity. Ultrasonography of abdomen showed multiple calcifications involving both kidneys in upper, middle and lower calyces suggesting nephrocalcinosis. CT SCAN of neck plain and contrast shows 3.4 9 1.7 cm cystic lesion with enhancing solid component noted inferior to right thyroid gland. MRI scan of the hip joints showed multiple cystic lesions of right ilium, left ilium, right femoral neck and upper shaft with pathological fracture of left femur neck. MRI scan of left knee joint showed expansion of the lower end of the femur with multiple cystic lesions and pathological fracture at metadiaphysial region (Fig. 2) with synovial effusion.Parathyroid scintigraphy and SPECT CT study was done. 15 mci of 99m Tc MIBI was injected intravenously. Early static images (15 min), delayed static images (40 min) and SPECT CT (20 min) were acquired. Early static image showed diffuse tracer activity of both lobes of thyroid gland with more intense activity at right lower lobe. Delayed static scans showed intense tracer activity at the right lobe of the lower aspect of thyroid gland with wash out of the tracer from the remaining part of the gland. SPECT CT study confirmed 3.88 9 1.7 cm soft tissue density nodule at the lower pole of right lobe of thyroid gland.Under a definitive diagnosis of parathyroid adenoma, targeted excision of the enlarged right inferior parathyroid adenoma was ...