Reversible hypercalcemic cerebral vasoconstriction with seizures and blindness: a paradigm for eclampsia?
Although hypercalcemia may cause drowsiness, lethargy, weakness, confusion and coma it rarely causes seizures or cerebral infarction. The patient presented had a clinical evolution from hallucinosis to a generalized tonic-clonic seizure, and subsequent cortical blindness with occipital cerebral ischemia as evidenced by SPECT and MRI scans. EEG revealed occipital PLEDs. With reversal of hypercalcemia, there was a return of vision, resolution of EEG epileptiform activity, although with some residual occipital infarction. This case, in concert with a literature review of hypercalcemia, reveals examples of occipital and watershed ischemia, blindness, seizures and hypertension, a pattern markedly similar to that of eclampsia. Furthermore, medications such as magnesium sulfate, believed to reverse cerebrovasospasm responsible for the eclamptic neurologic findings, may counter the effects of hypercalcemia at a cellular level, lending support to a calcium-mediated injury in eclampsia.
Kaplan
P W
PW
Department of Neurology, Johns Hopkins Bayview Medical Center, Baltimore, Maryland 21224, USA.
D000368:Aged; D019575:Blindness, Cortical / Q000175:diagnosis / Q000503:physiopathology*; D001931:Brain Mapping; D002540:Cerebral Cortex / Q000503:physiopathology; D004292:Dominance, Cerebral / Q000502:physiology; D004569:Electroencephalography; D004830:Epilepsy, Tonic-Clonic / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000175:diagnosis / Q000503:physiopathology*; D002546:Ischemic Attack, Transient / Q000175:diagnosis / Q000503:physiopathology*; D011225:Pre-Eclampsia / Q000175:diagnosis / Q000503:physiopathology*; D011247:Pregnancy; D012640:Seizures / Q000175:diagnosis / Q000503:physiopathology*; D015899:Tomography, Emission-Computed, Single-Photon