All in One: Varied Manifestations of Hypocalcemia in the Same Patient

Introduction: The calcium ion plays a critical role in normal cellular functioning and signaling neuro muscular signaling, cardiac contractility, hormone secretion and blood coagulation. The extra cellular calcium levels are maintained within a narrow range through a series of feedback mechanisms that involve parathormone and vitamin D.

Materials: Herein we present a patient with hypocalcemia who presented with many of its features. A 65 year old female came with complaints of new onset seizures. She was a known case of hypothyroidism since 20 years. She had history of thyroidectomy surgery 25 years back. Shes also hypertensive. On examination she was conscious, oriented. vitals stable. Tone was reduced in all 4 limbs. Blood investigations were normal except for low serum calcium levels. CT brain showed bilateral symmetrical classification in the basal ganglia and cerebellar dentate nuclei. ECG short QT prolongation. Serum parathormone levels were low. Post surgical hypothyroidsm with hypoparathyroidsm led to chronic hypocalcemia and the present features.

Result: Chvosteks sign Trousseau sign QT prolongation Bilateral basal ganglia calcification- Fahrs syndrome Conclusion: An interesting case of bilateral basal ganglia calcification due to hypocalcemia which also had other features of hypocalcemia.