Abstract

 Hypoparathyroidism can be associated with brain calcifications and varied neuropsychiatric manifestations. A 61 year old male presented with history of gradually progressive behavioural disturbances, initially diagnosed from outside hospitals as bipolar disorder and was on mood stabilisers since 40 years of age. Presently patient had episodic twisting movements of neck suggestive of cervical dystonia, relieved by sensory tricks, for last one year. History of occasional paraesthesias of extremities was present. No family history of similar illness.

Evaluation showed low serum calcium and parathormone levels. Renal function and ultrasound neck was normal with no history of prior thyroid surgery or irradiation. Neuroimaging revealed extensive intracerebral calcifications in bilateral basal ganglia, thalami, centrum semiovale and cerebellum. Patient was given oral calcium supplementation with anticholinergics leading to some relief of dystonia. Hypoparathyroidism can be difficult to diagnose due to frequent atypical presentations,often misdiagnosed as primary psychiatric illness as in our patient.Further, clinical presentation as isolated cervical dystonia is very rare.

Keywords- Hypoparathyroidism, cervical dystonia, neuropsychiatric manifestations, intracerebral calcifications.