Clinical Images

Intracranial Abnormality

Authors: James Tasch DO, Ann McLaughlan DO, Wayne Bellucci MD

   A 79-year-old immunocompetent female with a past medical history of ruptured abdominal aortic aneurysm with emergent repair complicated by bilateral hemispheric cardioembolic strokes presented with acute altered mental status following a recent left hip arthroplasty secondary to a fall. There was no medical history of meningitis or meningeal carcinomatosis, but had a reported history of recurrent falls. Upon arrival, the patient developed acute respiratory distress and was emergently intubated. There were reports of excessive diarrhea prior to arrival, but additional review of systems was negative. On admission, potassium was 2.4, influenza A was positive, and Clostridium difficile toxin was present in the stool. Computer tomography (CT) scan of the head revealed extensive hemispheric calcifications. The patient was normocalcemic for all reported lab draws and had age-appropriate renal function. A course of appropriate antibiotic therapy was completed with the patient ultimately recovering, but did require a tracheostomy secondary to prolonged intubation and subglottic stenosis.

MCQ: What is the most likely cause of this intracranial calcification?

A: Neurocysticercosis

B: Recurrent subdural hemorrhages

C: Sturge-Weber syndrome

D: Pseudohypoparathyroidism

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References:

1. Ratcliffe JF, Shanley S, Ferguson J, Chenevix-Trench G. The diagnostic implication of falcine calcification on plain skull radiographs of patients with basal cell naevus syndrome and the incidence of falcine calcification in their relatives and two control groups. Br J Radiol. 1995 Apr;68(808):361-8. PMID: 7795971.
2. Akpinar E. The tram-track sign: cortical calcifications. Radiology. 2004 May;231(2):515-6. PubMed PMID: 15128996.

Authors:

James Tasch, DO and Ann McLaughlan, DO are internal medicine residents at Arnot Ogden Medical Center in Elmira, New York. Wayne Bellucci, MD is board certified in critical care medicine and pulmonary disease who specializes in pulmonary medicine at Arnot Ogden Medical Center in Elmira, New York.