The high rate of prevalence of CT-detected basal ganglia calcification in neuropsychiatric (CNS) brucellosis

Abstract

Of 65 cases presenting with neuropsychiatric manifestations of brucellosis (CNS-brucellosis), 9(13.8%) had CT-detected basal ganglia calcification (BGC). Of these, 5 had meningitis and 4 had psychiatric manifestations as presenting features. The diagnosis of brucellosis was made by the finding of consistent history and physical findings and the presence of significantly elevated antibody titres and/or positive culture in the blood and/or CSF. In all the cases, BGC was in the form of punctate hyperdense non-enhancing shadows with average density 44.5-58.4 and maximum density 49-64HU. The calcification was unilateral in 3 cases, bilateral and symmetrical in 4 and bilateral but asymmetrical in 2. None of the cases had other predisposing conditions to BGC and in one of the cases did specific anti-brucella treatment effect a detectable change in the BGC. The finding of CT-detected BGC in patients coming from areas endemic for brucellosis should alert physicians to the possibility of underlying brucellar infection.

Fahr’s syndrome: literature review of current evidence

“…Out of these, 5 had meningitis and 4 had psychiatric manifestations. Calcification was unilateral in 3 cases, bilateral and symmetric in 4 cases and bilateral but asymmetric in 2 [44]. …”

Neuroimaging of a New Familial Disorder; Ataxia, Chorea, Seizures, and Dementia

“…This was confirmed in 2 members of this family by the neuropathological findings, which revealed extensive perivascular and parenchymal deposits with mulberry bodies that stained for calcium and iron in the globus pallidus [1]. Localized BGC of pathological significance has also been reported in several diseases, including a child with Hallervorden-Spatz syndrome [8] and 5 young adults with brucellosis involving the central nervous system [4].…”

“…Two types of BGC are recognized: ( 1) localized BGC limited to the globus pallidus, detected by CT but rarely by plain skull radiographs; and (2) a diffuse or progressive BGC involving the globus pallidus, putamen, caudate, A dentate, and white matter, frequently detected on plain skull radiographs as well as on CT [3,4]. CT is five to 15 times more sensitive than are plain skull radiographs for detecting intracranial calcification [5].…”

The Psychopathology of Basal Ganglia Calcification

“…Basal ganglia calcification (BGC) has been described in association with a wide variety of conditions including parathyroid disease, hypothyroidism, epilepsy, Parkinson's disease and Down's syndrome (Lowenthal and Bruyn, 1968). It may also occur in patients who have sustained brain damage following anoxia, lead and carbon monoxide poisoning, intracranial infection such as congenital rubella, toxoplasmosis, brucellosis (Mousa et at., 1987) and AIDS (Belman et at., 1986) and the administration ofmethotrexate or cerebral radiotherapy (Murphy, 1979).…”