Intracranial calcifications - Applied Radiology Online

Intracranial calcifications 

Erini Makariou, MD, and Athos D. Patsalides, MD 

Intracranial calcifications seen on 

computed tomography (CT) are the 

most common finding in the everyday 

practice of neuroradiology, because 

noncontrast-enhanced CT of the head is 

the preferred imaging modality worldwide 

for the initial evaluation of patients 

with acute or chronic neurological 

problems. The intracranial calcifications 

may have no clinical importance 

or they may be critical findings in 

diagnosing the underlying pathology. 

In this article, we illustrate a broad 

spectrum of common and uncommon 

central nervous system (CNS) disorders 

associated with calcifications. In 

order to provide a systematic review 

and an approach to a more accurate 

diagnosis, we present the intracranial 

calcifications according to the underlying 

etiology. The neoplastic processes 

are subdivided according to location 

(Table 1). 

Physiologic calcifications 

The physiologic calcifications are 

very common and have been welldescribed 

in the past decades. They are 

associated with aging and can be seen 

in the basal ganglia, pineal gland, falx, 

tentorium, arachnoid granulations, 

choroid plexus and the cerebellum. 

Physiologic calcifications are almost 

never clinically significant. The calcifications 

in the basal ganglia are usually 

Dr. Makariou is an Associate Professor 

of Radiology, Department of Radiology, 

Georgetown University Hospital, Washington, 

DC. and Dr. Patsalides is an 

Assistant Professor of Radiology in Neurological 

Surgery, Weill Cornell Medical 

College, New York, NY. 

48 ■ APPLIED RADIOLOGY © 

punctate and are located within the 

globus pallidus, the head of the caudate 

nucleus, and the putamen and are very 

common in middle-aged individuals 

and the elderly (Figure 1). However, 

basal-ganglia calcifications in persons 

Physiologic 

Posttraumatic and dystrophic 

Subdural/epidural hematoma 

Radiation/chemotherapy 

Ischemia/infarct 

Although radiation therapy and 

chemotherapy probably have a synergistic 

role in the pathogenesis, radiation 

is the dominant factor in mineralizing 

microangiopathy. Finally, ischemic and 

hemorrhagic infarcts, parenchymal hemorrhage 

from trauma, and prior surgery 

are also associated with dystrophic 

calcifications. 

Congenital disorders/phakomatoses 

The phakomatoses are a group of 

hereditary disorders that affect structures 

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Table 1. Intracranial calcifications 

Congenital disorders (phakomatoses) 

Neurofibromatosis I and II 

Tuberous sclerosis 

Basal cell nevus syndrome 

Sturge-Weber syndrome 

Vascular disorders 

Vascular malformations: AVM/AVF, cavernous angioma, venous angioma, and 

capillary telengiectasia 

Aneurysm 

Intracranial atherosclerosis 

Ischemia/infarct 

Vein of Gallen malformation 

Infections 

Congenital: CMV, toxoplasmosis, HIV, herpes 

Acquired: Cysticercosis, tuberculosis, HIV, cryptococcosis 

Inflammatory disorders 

Sarcoidosis 

Systemic lupus erythematosus 

Tumors 

Intra-axial: Astrocytomas, oligodendroglioma, medulloblastoma, ganglioglioma, 

DNET, metastases 

Extra-axial: Meningioma, pineal tumors, pituitary tumors, craniopharyngioma, 

epidermoid/dermoid, teratoma, colloid cyst, lipoma, metastases 

Intraventricular: Ependymoma, choroid plexus tumors, central neurocytoma, 

metastases 

Metabolic 

Hyperparathyroidism 

Hypoparathyroidism 

Hypothyroidism 

Fahr disease 

MELAS syndrome 

of ectodermal origin. Classically, calcifications 

are described in tuberous sclerosis 

and Sturge-Weber syndrome but can 

also be seen in neurofibromatosis and 

basal-cell nevus syndrome. 

Calcified subependymal hamartomas 

are common findings in tuberous 

sclerosis, usually located along the 

ventricular surface of the caudate 

nucleus (Figure 6), just posterior to the 

foramen of Monro. The cortical 

hamartomas seen in tuberous sclerosis 

are usually supratentorial and can also 

INTRACRANIAL CALCIFICATIONS 

FIGURE 1. Physiologic calcifications in a 

51-year-old man with headache. Axial 

nonenhanced computed tomography (CT) 

image reveals physiologic calcifications of 

the basal ganglia bilaterally. 

Table 2. Basal ganglia 

calcifications 

Physiologic/normal senescent 

(most common) 

Metabolic 

Hypoparathyroidism (including 

pseudo- and pseudopseudohypoparathyroidism) 

Hyperparathyroidism 

Hypothyroidism 

Lead toxicity 

Fahr disease 

Hallevorden Spatz disease 

Ischemic 

Carbon monoxide intoxication 

Birth anoxia 

Infectious 

AIDS 

TORCH encephalitis 

Toxoplasmosis 

Cysticercosis 

Congenital 

Trisomy 21 

Tuberous sclerosis 

Neurofibromatosis 

Chemotherapy (methotrexate) 

Radiation therapy 

www.appliedradiology.com APPLIED RADIOLOGY © 

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FIGURE 2. Physiologic calcifications in a 55year-old 

woman with headache. Axial 

nonenhanced CT image reveals physiologic 

calcifications of the pineal gland and the 

choroid plexuses bilaterally. 

A B 

calcify. Calcifications in the subependymal 

and cortical hamartomas are 

rare during the first year of life and 

the rate increases along with the 

patient’s age. 

Subependymal giant-cell astrocytomas 

are another major manifestation 

of tuberous sclerosis that can present 

as a calcified nodule. These lesions are 

larger than the subependymal nodules, 

show interval growth, enhance on postcontrast 

images and are located at or 


FIGURE 3. Calcified falx in a 46-year-old 

woman with subarachnoid hemorrhage. 

Axial nonenhanced CT image shows dense 

calcifications of the anterior falx. Subarachnoid 

hemorrhage is seen in the sulci of the 

right parietal lobe. 

FIGURE 5. 50-year-old man with chronic right subdural hematoma. Axial nonenhanced CT 

image (A) shows a chronic, right, subdural hygroma with calcifications along the inner surface. 

Axial CT image of the skull in bone windows (B) shows calcifications. 

near the foramen of Monro. 9 Gyriform 

cortical calcifications, with a pattern 

similar to Sturge-Weber, are sometimes 

seen as well. 10 

The most common calcifications 

seen in patients with neurofibromatosis 

type 2 (NF2) are the ones associated 

with disease-related tumors, such as 

meningiomas. Nontumoral calcifications 

have also been described in these 

patients, with symmetric or asymmetric 

calcifications of the choroid plexus 

FIGURE 4. Physiologic calcifications of the 

dentate nuclei in a 86-year-old woman. Axial 

nonenhanced CT image shows prominent 

symmetric calcifications in the dentate 

nuclei bilaterally. 

FIGURE 6. 21-year-old patient with tuberous 

sclerosis presents with seizures and 

mental retardation. Axial noncontrast CT 

image reveals calcified subependymal 

hamartomas along the lateral ventricles and 

the region of the foramina of Monro. The 

largest lesion adjacent to the left foramen of 

Monro is a giant cell astrocytoma. 

in the lateral ventricles and nodular 

calcifications of the cerebellum 11 being 

most commonly observed. Cortical 

calcifications are less common. Vouge 

et al. 12 described subependymal calcifications 

in a series of patients with NF2, 

similar to the calcifications seen in 

tuberous sclerosis. 

www.appliedradiology.com November 2009


FIGURE 7. 21-year-old patient with basal 

cell nevus syndrome. Axial noncontrast 

CT image shows dense calcification along 

the falx. 

FIGURE 9. Atherosclerosis of the intracranial 

arteries in a 70-year-old man. Axial 

nonenhanced CT image (bone algorithm) 

shows wall calcifications of the supraclinoid 

internal carotid arteries. 

Early dural calcifications are a common 

manifestation of the basal-cell 

nevus syndrome; they involve the falx 

(Figure 7), the diaphragma sella and 

the tentorium. These are also locations 

of physiologic calcifications, but in 

patients with basal-cell nevus syndrome, 

the calcifications appear in 

younger age groups. 13 One of the typical 

imaging findings in Sturge-Weber 


A B 

FIGURE 8. Six-year-old boy with Sturge-Weber syndrome. Posterioanterior radiograph (A) of 

the skull shows tram-track calcifications of the right side of the head. Axial nonenhanced CT 

image (B) shows dense gyriform calcifications in the cortex of the right frontotemporal region 

with associated brain volume loss. There is compensatory dilatation of the right lateral ventricle. 

FIGURE 10. Atherosclerosis of the left vertebrobasilar 

system in a 41-year-old man 

with lymphoma, status post kidney transplantation. 

Axial nonenhanced CT image 

reveals an elongated prominent left vertebrobasilar 

artery with wall calcifications. 

syndrome is calcification occurring 

adjacent to a pial angioma, originating 

in the subcortical white matter and 

then extending to the cortex (Figure 8). 

The parieto-occipital cortex is the most 

common location for cortical calcifications, 

but they may occur anywhere in 

the cerebrum. In 20% of patients these 

calcifications are bilateral. 14 

Vascular calcifications 

Calcifications in the arterial wall of 

large intracranial vessels are common 

and should be mentioned in the report 

because of their association with atherosclerosis. 

It is also important to be 

aware of other calcification patterns 

associated with vascular pathology, 

such as vascular malformations and 

aneurysms. 

Atherosclerosis is associated with 

mural calcifications of the major intracranial 

arteries. 15 The carotid siphon 

(Figure 9) is the most commonly 

affected vessel, while calcifications in 

the anterior and middle cerebral arteries 

and the vertebrobasilar system 

(Figure 10) are less common. 

Arteriovenous malformations (AVMs) 

are associated with dystrophic intracranial 

calcifications. These are seen in 

the watershed or other areas away from 

the AVM nidus due to ischemic brain 

tissue as a result of the “vascular steal” 

from the AVM. 16 Calcification can also 

be seen in the AVM nidus. 17 AVMs are 

associated with mural calcifications in 

the ectatic veins associated with the 

fistula. 18 Patients with cavernous 

angiomas (Figure 11) often have stippled 

calcifications 19 in the vessel wall 

or the adjacent brain parenchyma. 


A B 

FIGURE 11. Cavernous angioma in the pons of a 30-year-old man with headaches. Axial 

nonenhanced CT image (A) reveals a round hyperdense lesion with punctate calcifications in 

the pons. There is no associated mass effect or surrounding edema. Hyperdense foci in CSF 

spaces are Pantopaque residue from a previous myelogram. T2-weigheted (T2W) magnetic 

resonance (MR) image (B) at the level of the pons shows a lesion with mixed signal intensity 

and a rim of low signal intensity due to hemosiderin deposition. 

A B 

FIGURE 12: Calcifications related to a venous angioma in a 50-year-old woman with 

headaches. Axial nonenhanced CT image (A) shows a wedge-shaped calcified area in the left 

frontal lobe. Coronal nonenhanced T1-weighted (T1W) MR image (B) reveals the classic 

appearance of a venous angioma in the left frontal lobe (arrow). 

These are more commonly seen in 

nonhemorrhagic lesions. 20 Calcifications 

in developmental venous anomalies 

(venous angioma, Figure 12) and 

capillary telangiectasias have been 

occasionally described. 21–23 Brain aneurysms 

(Figure 13) often have mural 

calcifications, more often seen in fusiform 

24 compared with saccular aneurysms. 

Amyloid angiopathy results in 

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gyriform calcification and sclerotic 

changes in the medullary arteries. 25 

Congenital infections 

Intracranial calcifications are common 

in patients with congenital infections, 

but their appearance is not 

specific because they reflect dystrophic 

calcifications similar to any chronic 

brain injury. Basal ganglia and cortical 


A 

FIGURE 13. 75-year-old man with a giant 

thrombosed left ICA aneurysm. Lateral radiograph 

of the skull (A) shows a round lesion 

with rim calcifications in the suprasellar 

region. Coronal postcontrast CT image (B) 

shows a peripherally calcified round lesion in 

the suprasellar region without enhancement. 

The left middle and anterior cerebral arteries 

are not visualized. Lateral view of a left 

carotid angiogram (C) reveals no enhancement 

of the round calcified lesion. 

calcifications are common features of 

all infections that constitute the 

TORCH syndrome (toxoplasmosis, 

other, rubella, cytomegalovirus, herpes 

simplex virus). 

Cytomegalovirus and toxoplasmosis 

(Figure 14) infections result in periventricular 

and subependymal calcifications. 

26 Interestingly, calcifications in 

patients infected with toxoplasmosis 


B 

C 

■ 53


FIGURE 14. Congenital toxoplasmosis in a 

6-year-old boy with seizures and mental 

retardation. Axial noncontrast CT image 

reveals dense calcifications in the basal 

ganglia and subcortical white matter bilaterally. 

There is brain volume loss with 

colpocephaly. 

may resolve after treatment. 27 Congenital 

HIV infection (Figure 15) is associated 

with periventricular frontal 

white-matter and cerebellar calcifications. 

28 Congenital herpes (HSV-2) 

infection is associated with thalamic, 

periventricular, and punctate cortical 29 

or extensive gyral calcifications. 30 

Acquired infections 

Cysticercosis, tuberculosis, HIV and 

cryptococcus are the most common 

acquired intracranial infections typically 

associated with calcifications. As 

in the case of congenital infections, the 

pattern of calcification is not specific 

but is still useful in making the diagnosis 

and evaluating disease progression. 

In cysticercosis (Figure 16), calcifications 

are seen in the dead larva (granular-nodular 

stage) and the typical 

appearance is that of a small, calcified 

cyst containing an eccentric calcified 

nodule that represents the dead scolex. 

The most common locations for the calcifications 

are the subaracnhoid spaces 

in the convexities, ventricles, and basal 

cisterns and the brain parenchyma, especially 

the gray-white matter junction. 

Tuberculosis results in calcified 

parenchymal granulomata in 10% to 


A B 

FIGURE 15. 5-year-old boy with congenital HIV infection with generalized atrophy. Axial 

nonenhanced CT image (A) shows calcifications in the subcortical white matter of the frontal 

lobes and the dentate nuclei. Axial nonenhanced CT image (B) shows additional calcifications 

in the basal ganglia bilaterally. 

20% of patients; 31 meningeal calcifications 

are much less common. HIV 

encephalitis is associated with basal 

ganglia calcification. 32 Cryptococcus 

affects immunocompromised patients 

and calcifications can be seen in both 

the brain parenchyma 33 and the leptomeninges. 

34 

Inflammatory lesions 

Sarcoidosis involves the leptomeninges, 

producing granulomas of the 

pituitary stalk and the optic chiasm. 

Calcified sarcoid granulomas can also 

be seen in the pituitary, pons, hypothalamus 

and the periventricular white 

matter. Systemic lupus erythematosus 

(Figure 17) has been associated with 

cerebral calcifications in the basal ganglia, 

thalamus, cerebellum and centrum 

semiovale. 35 

Tumors 

Commonly calcified intracranial 

tumors include the oligodendrogliomas, 

low-grade astrocytomas, craniopharyngiomas, 

meningiomas, pineal gland 

tumors and the ependymomas. Since 

many tumors have overlapping imaging 

findings, knowing which tumors calcify 

is useful in limiting the differential 

diagnosis. In some instances, the presence 

and pattern of calcification can be 

essentially pathognomonic as in the 

case of oligodendrogliomas and craniopharyngiomas. 

We present the intracranial tumors 

that calcify divided into intra- and extraaxial 

and intraventricular, in order to 

make the differential diagnosis more 

meaningful. The presence or absence of 

calcifications is not related to the benign 

or malignant nature of the tumor. 

Intra-axial tumors 

The diffuse low-grade astrocytomas 

(Figure 18) are the most common glial 

neoplasms demonstrating calcifications; 

however, only the minority of these 

tumors calcify. 36 The calcification can be 

linear, diffuse, punctate or multifocal 

and may follow the white-matter tracts, 

especially with large tumors. 37 Calcifications 

are present in the majority of 

subependymal giant-cell astrocytomas 

in the form of calcified chunks or nodules. 

38,39 Up to 25% of pilocytic astrocytomas 

have intratumoral calcification. 

Other astrocytomas such as the pleomorphic 

xanthostrocytoma, anaplastic 

astrocytomas and glioblastoma multiforme 

(Figure 19) only rarely calcify. 


A B 

C D 

FIGURE 16. Cysticercosis in a 32-year-old man with seizures and headaches. Axial nonenhanced 

CT image (A) shows several punctuate calcifications in the parenchyma and along the 

left frontal horn. Axial nonenhanced CT image (B) shows several punctuate calcifications in 

the parenchyma. Axial contrast-enhanced T1W MR image (C) shows enhancement of the left 

frontal horn lesion (arrow). Coronal contrast-enhanced T1W MR image (D) shows an enhancing 

lesion in the right temporal lobe (arrow). 

The oligodendrogliomas (Figure 20) 

exhibit the highest frequency of calcification 

among all brain tumors, since up to 

90% of them calcify. 40,41 The calcifications 

in oligodendrogliomas can be central 

or peripheral, punctate or ribbon like, 

usually located within walls of intrinsic 

tumor vessels. 42 Calcifications may even 

extend to the surrounding brain 

parenchyma. The medulloblastomas 

show small, clumplike or nodular calcifications 

in approximately 20% of cases. 43 

Calcifications are typically seen in the 

majority of gangliocytomas 44 and in 

November 2009 

approximately 40% of gangliogliomas 

(Figure 21). 45 The calcifications are more 

commonly seen in cystic rather than solid 

gangliogliomas. 46 Dysembryoplastic neuroepithelial 

tumors have a calcification 

pattern similar to oligodendrogliomas but 

only a small percentage of these tumors 

calcify. 47 Calcified intracranial metastases 

(Figure 22) are very rare and have been 

primarily described in case reports. 48 The 

osteogenic sarcoma, lung and breast carcinomas 

are the most common primary 

tumors with brain metastases that 

calcify. 49 


Extra-axial tumors 

The percentage of meningiomas 

(Figures 23–25) that calcify ranges 

from 20% to 69%. 36,50 The calcifications 

can be focal, diffuse, coarse, sand-like 

or even rim. There is a higher percentage 

of calcified meningiomas in children, 

which could be associated with 

more aggressive subtypes of meningiomas. 

51 Pineal gland calcifications are 

very common: seen in approximately 

40% of normal people by the age of 

20 years. 1 Compact pineal calcifications 

measuring


FIGURE 18. Low-grade astrocytoma in a 75year-old 

woman. Axial nonenhanced CT image 

shows a left posterior frontal/parietal mass 

with dense calcifications, surrounding edema 

and mass effect on adjacent parenchyma. 

A 

B 

FIGURE 21. 25-year-old man with ganglioglioma 

in the right temporal lobe. Axial 

nonenhanced CT image (A) shows a completely 

calcified lesion in the right temporal 

lobe without associated edema or mass 

effect. Axial nonenhanced CT image (B, bone 

algorithm) shows the densely calcified lesion 

in the right temporal lobe. 


FIGURE 19. Gliobastoma multiforme in a 

44-year-old. Axial nonenhanced CT image 

shows a heterogenous lesion with peripheral 

irregular calcifications in the left basal ganglia 

region with a large zone of surrounding vasogenic 

edema. The lesion produces mass 

effect on the lateral ventricles and midline 

shift to the right. 

A B 

not associated with underlying pathology. 

Larger pineal gland calcifications 

however, are worrisome for pineal 

gland tumors. 

Among the pineal cell parenchymal 

tumors, the pineocytomas are the ones 

that calcify more frequently, showing 

FIGURE 20. 35-year-old man with left frontal 

oligodendroglioma and history of seizures. 

Axial nonenhanced CT image shows a 

round lesion with peripheral calcifications 

and a small surrounding zone of edema. 

FIGURE 22. Calcified brain metastases in a 65-year-old-man with prostate cancer. Axial 

nonenhanced CT image (A) shows a dense calcified lesion with surrounding vasogenic edema 

in the left frontal lobe. A calcified focus is seen in the right frontal lobe. Axial nonenhanced CT 

image (B) shows calcified lesions with a small zone of edema in both parietal lobes. 

either peripheral or central calcifications. 

Peripheral calcifications are 

thought to be native pineal body calcifications 

displaced by the tumor, 

whereas the central calcifications are 

produced by the tumor itself. 52 Among 

the pineal tumors arising from germ 


A B 

FIGURE 23. 58-year-old woman with a calcified occipital meningioma. Axial nonenhanced CT 

image (A) shows a calcified, broad-based, extra-axial lesion in the occipital regions. Axial 

nonenhanced CT image (B, bone algorithm) shows the calcified lesion in the occipital regions. 

A B 

FIGURE 25. Small suprasellar calcified meningioma in a 78-year-old woman. Axial nonenhanced 

CT image (A) shows a round, well-defined, calcified lesion in the suprasellar region. 

Axial nonenhanced CT image (B, bone algorithm) shows the calcification.The same lesion on 

MRI is isointense on T1W and hypointense on T2W images with a dural tail and minimal 

peripheral enhancement (not shown). 

cells, teratomas commonly have dense 

calcifications. The germinomas very 

rarely calcify but may displace or 

engulf preexisting physiologic pineal 

gland calcifications. 53 Seventy percent 

to ninety percent of craniopharyngiomas 

(Figure 26) are seen in children 

with calcifications, and 30% to 40% of 

craniopharyngiomas are seen in adults 

who have calcifications. This is 

explained by the different histology of 

the tumor in different age groups; the 

November 2009 

adamantinous craniopharyngiomas are 

usually seen in children and almost 

always (90%) calcify either in the 

periphery and/or the solid component 

of the tumor. 54 The squamous papillary 

craniopharyngiomas are more often 

seen in adults and are less likely to calcify. 

Dermoid and epidermoid tumors 

show peripheral stippled calcification 

in approximately 20% to 25% of cases 55 

while teratomas typically show internal 

calcifications. 56 Pituitary adenomas do 


FIGURE 24. 69-year-old woman with partially 

calcified meningioma. Axial nonenhanced CT 

image shows a broad-based, partially calcified, 

extra-axial lesion in the right cerebellopontine 

angle. There is associated hyperostosis 

of the petrous bone and mass effect 

on the pons and right cerebellum. 

not calcify frequently. They should be 

suspected however, when calcification 

is seen within the pituitary gland. 57,58 

Pericallosal and interhemispheric 

lipomas may show calcification of the 

fibrous capsule with rim or eggshell 

appearance. The calcification can also 

be located in the center of the lipoma. 

Lipomas located elsewhere, are much 

less likely to show calcifications. 59,60 

Colloid cysts rarely calcify. 61 

Intraventricular tumors 

Intraventricular ependymomas typically 

calcify, ranging from punctate 

to mass-like calcifications. 62,63 Posterior 

fossa ependymomas exhibit small, round 

calcifications up to 50% 64 and have the 

highest frequency of calcification among 

the posterior fossa tumors. The subependymomas 

calcify in approximately 

one third of cases and usually demonstrate 

small foci of calcification. 65,66 The 

choroid plexus papillomas and carcinomas 

have punctate calcifications in 

approximately 25% of cases. 38 The central 

neurocytomas (Figure 27) were 

thought to characteristically show globular 

calcifications. 68 Other authors, however, 

reported calcifications in only 50% 


■ 57


A B 

FIGURE 26. Peripherally calcified craniopharyngioma in a 55-year-old woman complaining of 

headaches and vision disturbances. Axial nonenhanced CT image (A) shows a round, peripherally 

calcified lesion compromising the third ventricle, resulting in obstructive hydrocephalus. 

Coronal postcontrast T1W MR image (B) shows the suprasellar lesion with an enhancing rim. 

FIGURE 28. 45-year-old woman with intraventricular 

meningioma. Axial nonenhanced 

CT image shows a well-defined, ovoid, 

densely calcified lesion in the region of the 

third ventricle extending into the frontal 

horns. There is mild dilatation of the lateral 

ventricles. 

of these tumors. 67 The calcification in 

these tumors is variable, ranging from 

punctate to mass like. Intraventricular 

meningiomas (Figure 28) calcify in 

approximately 50% of cases, 62 with calcification 

patterns similar to the extraaxial 

meningiomas. 

Endocrine/metabolic/idiopathic 

Metabolic disorders affecting the 

calcium homeostasis are associated 

with intracranial calcifications that 


A B 

C D 

FIGURE 27. Calcified central neurocytoma in 

a 35-year-old with headaches. Axial nonenhanced 

CT image shows a densely calcified, 

well-defined, irregularly shaped mass in the 

region of the septum pellucidum and left 

frontal horn. The left frontal horn is enlarged. 

FIGURE 29. Progressive brain calcifications in a 31-year-old HIV-positive patient with renal 

failure on dialysis. Axial nonenhanced CT image (A) shows punctuate calcifications in the 

globus pallidus bilaterally and along the posterior falx. Calcifications are also seen along the 

tentorium, bilaterally (B). Five months later, another CT study of the head (C) showed marked 

progression of these calcifications in the globus pallidus, along the posterior falx and the tentorium 

bilaterally (D). 


A B 

FIGURE 30. 50-year-old man with hypoparathyroidism. Nonenhanced axial CT image (A) 

shows areas of calcifications in the subcortical white matter and the basal ganglia. Nonenhanced 

axial CT image (B) shows areas of calcifications in the subcortical white matter and 

the basal ganglia. 

predominantly involve the basal ganglia. 

Although the pattern is similar to 

the physiologic, age-related calcifications, 

they appear at younger ages and 

are often progressive. Basal ganglia 

and subcortical calcifications have been 

described in patients with chronic renal 

failure and secondary hyperparathyroidism 

(Figure 29). 69 In patients with 

hypoparathyroidism (Figure 30), the 

calcifications typically involve the 

basal ganglia, thalami, and the cerebellum. 

70 Intracranial calcifications are 

more commonly seen in the pseudorather 

than idiopathic hypoparathyroidism. 

71 Hypothyroidism is also associated 

with basal ganglia and cerebellar 

calcifications. 

Intracranial calcifications can also 

be seen in rare idiopathic disorders 

such as Fahr disease (bilateral striopallidodentate 

calcinosis, Figure 31). This 

disease shows characteristic calcifications 

in the basal ganglia, especially in 

the lateral globus pallidus. Other involved 

areas are the thalami, the cerebral 

white matter and the dentate 

nuclei of the cerebellum. 72 Progressive 

and symmetric basal ganglia calcifications 

are the commonest radiological 

finding of MELAS syndrome. 73 

November 2009 

Conclusion 

Knowledge of physiologic calcifications 

in the brain parenchyma is essential 

to avoid misinterpretations. However, 

several pathologic conditions 

involving the brain are associated with 

calcifications and the recognition of 

their appearance and distribution helps 

narrow the differential diagnosis. 

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