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Focal neurologic symptoms in hypercalcemia

Department of Medicine, Peter Rent Brigham Hospital, Boston, MA.

An unusual clinical presentation of moderate hypercalcemia as a result of primary hyperparathyroidism is described. The patient complained of fatigue, depression, thirst, polyuria, and focal neurologic symptoms including amaurosis fugax, anomia, right upper-extremity dysesthesias, and a left cerebral transient ischemic attack. No structural central nervous system abnormality could be documented. Signs and symptoms disappeared when serum calcium levels were reduced from 13.2 to 9.8 mg/100 ml. They have not recurred in 30 months of follow-up. The association of focal neurologic disease and hypercalcemia is uncommon. Although the precise pathophysiologic mechanism is unclear, this patient's symptoms suggest a vascular etiology.

Address correspondence and reprint requests to Dr. Witherspoon, Department of Medicine, Box 102, Medical College of Virginia, Richmond. VA 23298.

Accepted for publication July 11, 1979