Calcinosis Cutis in Children Following Electroencephalography

Abstract

A premature boy was transferred to a neonatal intensive care unit shortly after birth because of respiratory distress, jaundice, hepatosplenomegaly, thrombocytopenia, and an elevated IgM level. His course was complicated by pneumonia, congestive heart failure secondary to cor pulmonale, and repeated apneic episodes. His EEGs at 3 and 5 months of age were normal.Shortly after the second EEG, skin lesions were noted in the distribution of the previously applied EEG leads on his scalp and earlobes (Fig 1). Each lesion was a discrete, approximately 1-cm red papule surmounted by multiple yellowish milia. A biopsy specimen of one lesion showed a well-circumscribed, focal collection of calcium in the upper reticular dermis surrounded by a moderate infiltrate of histiocytes and lymphocytes (Fig 2).Six similar cases are summarized in the Table. Lesions disappeared in two to six months without therapy. During this time the lesions were tender, and tiny, hard bits of material were extruded. This period is slightly longer than previously noted in an adult.' In our experience, spontaneous resolution produces a result cosmetically superior to surgical removal.Abrasion of skin before application of electrode paste is a standard practice for EEG technicians.^At our hospital the technique is as follows:1. The areas selected for electrode placement are wiped with acetone.

A Non-Adhesive Solid-Gel Electrode for a Non-Invasive Brain–Machine Interface

“…Furthermore, one of the main reasons for adopting calcium chloride was that some commercial EEG pastes already contain calcium (for example, Weaver and Co., Ten20 Conductive Paste; Nihon Kohden, Elefix). Although calcinosis has been reported after using a calcium-containing electrode paste (Wiley and Eaglstein, 1979; Mancuso et al, 1990; Puig et al, 1998), we have not seen unfavorable cases in our experiments. However, we prefer magnesium chloride to calcium chloride for future work because we obtained similar results from the electrodes using either of them in preliminary testing.…”

Calcinosis Cutis Following Calcium Chloride Electrode Paste Application for Auditory‐Brainstem Evoked Potentials Recording

“…The clinical presentations range from yellow plaques which eventually extrude amorphous chalky material or ulcerate (6) to verrucous crusty papules (8), red papules surrounded by yellowish milia (9), or hard nodules with a necrotic center (10). Examination of biopsy specimens demonstrates dermal calcium deposits which stain brown with von Kossa stain.…”

“…The low pH of calcium chloride can provoke protein precipitation, leading to coagulation necrosis. Experimental reproduction of the lesions has been achieved in experimental animals (1) and in healthy volunteers (6,9).…”

“…It has been occasionally reported following electroencephalographic (6,(8)(9)(10)(11)(12)(13) and electromyographic (14) studies at sites of electrode placement following application of an electrode paste containing calcium chloride. Prolonged exposure and slun microabrasions seem to increase the risk of this rare complication of electrode placement.…”

Severe Iatrogenic Calcinosis Cutis From Extravasated Calcium Gluconate

“…Lastly, iatrogenic calcinosis cutis most commonly occurs from extravasation of calcium or phosphate-containing solutions [ 3 ]. Iatrogenic calcinosis cutis has been reported in patients undergoing electroencephalography or electromyography with prolonged periods of exposure to saturated calcium-containing electrode paste [ 4 - 6 ]. Iatrogenic calcinosis cutis has also occurred in patients receiving subcutaneous injections of para-aminosalicylic acid, solid organ transplant recipients, and neonates receiving numerous heel venipuncture sticks [ 1 , 2 ].…”