Sub-acute posterior reversible encephalopathy associated with extrapyramidal signs induced by primary hyperparathyroidism: a case report and a revision of literature.
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Date
2014-01
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Abstract
Aims: We present the case of a subacute psycho-motor deterioration in the context of a
hypercalcemic state due to primary hyperparathyroidism inducing a posterior reversible
encephalopathy.
Presentation of Case: a 78 year-old man, affected by parkinsonism, developed a
subacute psycho-motor deterioration in the course of a month and presented to our
attention with generalized seizures. Biochemical analysis revealed hypercalcemia due to
primary hyperparathyroidism. After the surgical removal of a hyperfunctioning
parathyroid gland, we assisted to a dramatic improvement. Alongside with characteristic
MRI findings, the picture was compatible with a posterior reversible encephalopathy
syndrome (PRES).
Discussion: To date, this is the third reported case of PRES caused by primary
hyperparathyroidism. Our case appears peculiar because of the subacute onset of the
syndrome, and of the accompanying progressive worsening of a pre-existing
extrapyramidal syndrome. Also, the specific setting of radiologic findings and hormonal
anomalies points to a prominent role of endothelial dysfunction in the still debated
pathogenesis of PRES. Conclusion: Our case presents a rare combination of hyperparathyroidism, PRES and
parkinsonism. We propose that the Blood-Brain barrier plays a central role in this setting.
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Keywords
Posterior reversible encephalopathy syndrome, hyperparathyroidism, primary, hypercalcemia, parkinsonian disorders, blood-brain barrier
Citation
Giani L, Lovati C, Bana C, Cova I, Angeli F De, Mariotti C, D’Alessandro, Mariani C. Sub-acute posterior reversible encephalopathy associated with extrapyramidal signs induced by primary hyperparathyroidism: a case report and a revision of literature. International Neuropsychiatric Disease Journal. 2014 Jan-Feb 2(1): 13-20.