Vasoconstriction as the etiology of hypercalcemia-induced seizures.
OBJECTIVE
Reversible cerebral vasoconstriction has been hypothesized to be the etiology of seizures due to hypercalcemia, but angiographic studies documenting vasoconstriction have not previously been available.


METHODS
We present a 43-year-old woman who had frequent seizures that later evolved to status epilepticus with marked hypercalcemia at the time of the seizures.


RESULTS
Magnetic resonance imaging (MRI) of the patient's brain revealed high signal changes in T(2)-weighted imaging, fluorescence-attenuated inversion recovery (FLAIR), and diffusion-weighted imaging (DWI) over the bilateral occipital and thalamic areas. Cerebral angiography showed blood vessels narrowing, disappearing altogether over the right posterior cerebral artery (PCA) branch, which is compatible with vasoconstriction. Vasoconstriction caused the MRI high signal in the occipital area, which was associated with subsequent periodic lateralized epileptic discharges. The patient's clinical condition improved with management of seizures and hypercalcemia. A second brain MRI 2 weeks later revealed complete resolution of the high-signal lesions. Follow-up cerebral angiography study also showed total recovery of vasoconstriction.


CONCLUSIONS
The sequence of events suggests the hypothesis that reversible cerebral vasoconstriction may play a role in hypercalcemia-induced seizures.
Chen
Tsung-Hua
TH
Department of Neurology, Kaohsiung Chang-Gung Memorial Hospital, Kaohsiung, Taiwan.
Huang
Chih-Cheng
CC
Chang
Yung-Yee
YY
Chen
Ying-Fa
YF
Chen
Wei-Hsi
WH
Lai
Shung-Lon
SL
D000328:Adult; D001921:Brain / Q000473:pathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D002533:Cerebral Angiography; D002539:Cerebral Arterial Diseases / Q000175:diagnosis / Q000000981:diagnostic imaging / Q000473:pathology; D002561:Cerebrovascular Disorders / Q000175:diagnosis / Q000209:etiology* / Q000473:pathology; D038524:Diffusion Magnetic Resonance Imaging; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000150:complications* / Q000209:etiology* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D009778:Occipital Lobe / Q000098:blood supply; D012640:Seizures / Q000209:etiology* / Q000473:pathology / Q000503:physiopathology; D014661:Vasoconstriction / Q000502:physiology