Skip to main content

Advertisement

Log in

Cerebellopontine calcification: a new entity of idiopathic intracranial calcification?

  • Case Report
  • Published:
Acta Neuropathologica Aims and scope Submit manuscript

Abstract

We report the autopsy case of a 40-year-old woman with severe intellectual and motor disabilities, who showed calcification in the cerebellum and pons but not in the basal ganglia on CT scan, and died of intracranial hemorrhage due to intractable hypertension. At autopsy, numerous calcium deposits were noted in the cerebellar cortex, the dentate nucleus, the cerebellar white matter and the ventral pons. These deposits were distributed both in the neuropil and the white matter, but rarely within the arterial walls or in contact with capillaries. This weak relationship between calcification and the blood vessels, in addition to the paucity of basal ganglia calcification, is in contrast to the findings with other disorders involving intracranial calcification, including Fahr’s disease and calcium metabolism disorders. Immunohistochemistry revealed intense staining of calbindin-D28K and parvalbumin at sites of calcium deposits both in the present case and in a case of pseudohypoparathyroidism, whereas these proteins were not localized to calcium deposits in the cerebellum of a Fahr’s disease brain. We propose that the present case may represent a distinct entity among diseases characterized by idiopathic intracranial calcification. In addition, calcium-binding proteins may be involved in the calcification process in some cases with intracranial calcification.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Acencio Marchante R, Acosta Varo J, Bascuñana Quirell A, López Sánchez A (1981) Calcificación cerebelosa idiopáthica [Idiopathic cerebellar calcification]. Med Clin 76:42–43

    Google Scholar 

  2. Anders KH, Becker PS, Holden JK, Sharer LR, Cornford ME, Hansen LA, Hamilton R, Vinters HV (1993) Multifocal necrotizing leukoencephalopathy with pontine predilection in immunosuppressed patients: a clinicopathological review of 16 cases. Hum Pathol 24:897–904

    Article  CAS  PubMed  Google Scholar 

  3. Baimbridge KG, Celio MR, Rogers JH (1992) Calcium-binding proteins in the nervous system. Trends Neurosci 15:303–308

    CAS  PubMed  Google Scholar 

  4. Barkovich JA, Lindan CE (1994) Congenital cytomegalovirus infection of the brain: imaging analysis and embryonic considerations. Am J Neuroradiol 15:703–715

    CAS  PubMed  Google Scholar 

  5. Bastianelli E (2003) Distribution of calcium-binding proteins in the cerebellum. Cerebellum 2:242–262

    Article  CAS  PubMed  Google Scholar 

  6. Celio MR (1990) Calbindin D-28k and parvalbumin in the rat nervous system. Neuroscience 35:375–475

    CAS  PubMed  Google Scholar 

  7. D’Cruz OF, Swisher CN, Jaradeh S, Tang T, Konkol RJ (1993) Möbius syndrome: evidence for a vascular etiology. J Child Neurol 8:260–265

    PubMed  Google Scholar 

  8. De Rosso AL, Maranhao Filho Pde A, De Oliveira EA, Novis SAP (1992) Diffuse encephalic calcification. Arq Neuropsiquiatr 50:519–522

    PubMed  Google Scholar 

  9. Faucheux C, Bareille R, Amedee J (1998) Synthesis of calbindin-D28K during mineralization in human bone marrow stromal cells. Biochem J 333:817–823

    CAS  PubMed  Google Scholar 

  10. Fulop M, Zeifer B (1991) Case report: extensive brain calcification in hypoparathyroidism. Am J Med Sci 302:292–295

    CAS  PubMed  Google Scholar 

  11. Fujita D, Terada S, Ishizu H, Yokota O, Nakashima H, Ishihara T (2003) Immunohistochemical examination on intracranial calcification in neurodegenerative diseases. Acta Neuropathol 105:259–264

    Google Scholar 

  12. Goel A, Bhatnagar MK, Vashishta A, Verma NPS (1994) Hypoparathyroidism with extensive intracranial calcification: a case report. Postgrad Med J 70:913–915

    CAS  PubMed  Google Scholar 

  13. Govaert P, Vanhaeserbouck P, De Praeter C, Fränkel U, Leroy J (1989) Moebius sequence and prenatal brain ischemia. Pediatrics 84:570–573

    CAS  PubMed  Google Scholar 

  14. Guseo A, Boldizsár F, Gellért M (1975) Elektronenoptische Untersuchungen bei “striato-dentaler Calcifikation” (Fahr) [Electron microscopic study of striatodental calcification (Fahr)]. Acta Neuropathol (Berl) 31:305–313

    Google Scholar 

  15. Harding BN, Surtees R (2002) Metabolic and neurodegenerative diseases of childhood. In: Graham DI, Lantos PL (eds) Greenfield’s neuropathology, 7th edn, Vol 1. Arnold, London, pp 486–517

  16. Illum F, Dupont E (1985) Prevalence of CT-detected calcification in the basal ganglia in idiopathic hypoparathyroidism and pseudohypoparathyroidism. Neuroradiology 27:32–37

    Article  CAS  PubMed  Google Scholar 

  17. Itota T, Tashiro Y, Torii Y, Nishitani Y, McCabe JF, Yoshiyama M (2004) Calbindin D-28k distribution in odontoblasts underneath tertiary dentine in human carious teeth. Arch Oral Biol 49:37–43

    Article  CAS  PubMed  Google Scholar 

  18. Iwasaki Y, Kinoshita M, Takamiya K (1988) Rapid development of basal ganglia calcification caused by anoxia. J Neurol Neurosurg Psychiatry 51:449–450

    PubMed  Google Scholar 

  19. Kawakami Y, Nakao Y, Tabuchi K, Nosaka Y, Ohmoto T (1978) Bilateral intracerebellar calcification associated with cerebellar hematoma. Case report. J Neurosurg 49:744–748

    Google Scholar 

  20. King AB, Gould DM (1952) Symmetrical calcification in the cerebellum. Am J Rheumatol 67:562–568

    CAS  Google Scholar 

  21. Kobari M, Nogawa S, Sugimoto Y, Fukuuchi Y (1997) Familial idiopathic brain calcification with autosomal dominant inheritance. Neurology 48:645–649

    CAS  PubMed  Google Scholar 

  22. Kobayashi S, Yamadori I, Miki H, Ohmori M (1987) Idiopathic nonarteriosclerotic cerebral calcification (Fahr’s disease): an electron microscopic study. Acta Neuropathol (Berl) 73:62–66

    Google Scholar 

  23. Koller WC, Klawans HL (1980) Cerebellar calcification on computerized tomography. Ann Neurol 7:193–194

    Article  CAS  PubMed  Google Scholar 

  24. Kumar D, Rittey C, Cameron AH, Variend S (1998) Recognizable inherited syndrome of progressive central nervous system degeneration and generalized intracranial calcification with overlapping phenotype of the syndrome of Aicardi and Goutières. Am J Med Genet 75:508–515

    Article  CAS  PubMed  Google Scholar 

  25. Lowe JS, Leigh N (2002) Disorders of movement and system degenerations. In: Graham DI, Lantos PL (eds) Greenfield’s neuropathology, 7th edn, Vol 2. Arnold, London, pp 325–430

  26. Lowenthal A (1986) Striopallidodentate calcifications. In: Vinken PJ, Bruyn GW, Klawans HL (eds) Handbook of clinical neurology, vol 49. Extrapyramidal disorders. Elsevier Science Publishers, Amsterdam, pp 417–436

  27. Manyam BV (2005) What is and what is not ‘Fahr’s disease’. Parsinsonism Relat Disord 11:73–80

    Article  Google Scholar 

  28. Morgante L, Vita G, Meduri M, Di Rosa AE, Galatioto S, Coraci MA, Di Perri R (1986) Fahr’s syndrome: local inflammatory factors in the pathogenesis of calcification. J Neurol 233:19–22

    Article  CAS  PubMed  Google Scholar 

  29. Muenter MD, Whisnant JP (1968) Basal ganglia calcification, hypoparathyroidism, and extrapyramidal motor manifestations. Neurology 18:1075–1083

    CAS  PubMed  Google Scholar 

  30. Naderi S, Çolakoğlu Z, Lüleci G (1993) Calcification of basal ganglia associated with pontine calcification in four cases: a radiologic and genetic study. Clin Neurol Neurosurg 95:155–157

    Article  CAS  PubMed  Google Scholar 

  31. Noorbehesht B, Enzmann DR, Sullender W, Bradley JS, Arvin AM (1987) Neonatal herpes simplex encephalitis: correlation of clinical and CT findings. Radiology 162:813–819

    CAS  PubMed  Google Scholar 

  32. Prasad A, Madan VS, Buxi TB, Prasad ML (1991) Medulloblastoma with extensive calcification. Neuroradiology 33:447–448

    Article  CAS  PubMed  Google Scholar 

  33. Price DB, Hotson GC, Loh JP, Pontine calcification following radiotherapy: CT demonstration. J Comput Assist Tomogr 12:45–46

  34. Puvanendran K, Wong PK (1980) Idiopathic familial basal ganglia calcification associated with juvenile hypertension. J Neurol Neurosurg Psychiatry 43:288

    CAS  PubMed  Google Scholar 

  35. Raymond AA, Zariah AA, Samad SA, Chin CN, Kong NCT (1996) Brain calcification in patients with cerebral lupus. Lupus 5:123–128

    CAS  PubMed  Google Scholar 

  36. Reyes PF, Gonzalez CF, Zalewska MK, Besarab A (1986) Intracranial calcification in adults with chronic lead exposure. Am J Roentgenol 146:267–270

    CAS  Google Scholar 

  37. Rorke LB, Spiro AJ (1967) Cerebral lesions in congenital rubella syndrome. J Pediatr 70:243–255

    CAS  PubMed  Google Scholar 

  38. Schéda W (1970) Beiträge zur Histopathologie der Fahrshcen intrazerebralen Gefässverkaklung [Histopathology of Fahr’s intracranial calcification]. Psychiatr Neurol Med Psycol (Leipz) 22:413–418

    Google Scholar 

  39. Scotti G, Scialfa G, Tampieri D, Landoni L (1985) MR imaging in Fahr disease. J Comput Assist Tomogr 9:790–792

    CAS  PubMed  Google Scholar 

  40. Sener RN (1993) Tuberous sclerosis with calcification of the cerebellar folia: CT and MR findings. Am J Roentgenol 161:679

    CAS  Google Scholar 

  41. Shuto T, Ohtsubo Y, Sekido K, Iwamoto H, Yamamoto I (1996) Rapidly growing calcified cerebellar astrocytoma in infants. Childs Nerv Syst 12:107–109

    Article  CAS  PubMed  Google Scholar 

  42. Singh B, Shahwan SA, Singh P, Al-Deeb SM, Sharif H (1992) Mobius syndrome with basal ganglia calcification. Acta Neurol Scand 85:436–438

    CAS  PubMed  Google Scholar 

  43. Steinlin M, Blaser S, Boltshauser E (1998) Cerebellar involvement in metabolic disorders: a pattern-recognition approach. Neuroradiology 40:347–354

    Article  CAS  PubMed  Google Scholar 

  44. Takashima S, Becker LE (1985) Basal ganglia calcification in Down’s syndrome. J Neurol Neurosurg Psychiatry 48:61–64

    CAS  PubMed  Google Scholar 

  45. Troost D, Rossum A van (1984) Cerebral calcifications and cerebellar hypoplasia in two children: clinical, radiologic and neuropathological studies—a separate neurodevelopmental entity. Neuropediatrics 15:102–109

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Yoshiaki Saito.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Saito, Y., Shibuya, M., Hayashi, M. et al. Cerebellopontine calcification: a new entity of idiopathic intracranial calcification?. Acta Neuropathol 110, 77–83 (2005). https://doi.org/10.1007/s00401-005-1011-y

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00401-005-1011-y

Keywords

Navigation