A 51 y.o. woman presents with altered mental status occurring over months

her CT is shown

What could cause this extensive calcification?

Our patient had further history.  She had had personality changes for seven years.

Our pt was thought to have an oligodendroglioma.  Only 4% of  brain tumors are oligodendrogliomas.  They are most often diagnosed at age 40-50.  Personality change or seizures generally prompt the pt to seek attention.  The tumors prior to 2016 were diagnosed based on histology but now they must have an IDH mutation and 1p19q codeletion.  Treatment is usually surgical with chemotherapy in addition.

Brain calcifications are not unusual.  There are many causes

Neoplastic causes :Brain tumors like oligodendroglioma, medulloblastoma , primitive neuroendocrine tumors  and gangliogliomas can cause calcifications. Meningioma often calcify.

Vascular causes:  include cavernous malformations, AVMs and chronic vasculitis.

Infectious causes include: TORCH, CMV, herpers  and parasites.

Congenital causes include: Sturge Weber and neurofibromatosis.

sturge weber can also lead to calcifications but is usually found in children because of the Port wine stain on the skin.

Gezercan U, Acik V, Cavus G, et al. Six different extremely calcified lesions of the brain: brain stones. 2016 Springerplus 5(1):1941.  PMID: 27917338.

Vogazianou A, Chan R, Backlund L, et al. Distinct patterns of 1p and 19q alterations identify subtypes of human gliomas that have different prognoses. 2010, Neuro-oncology. 12(7);664-78.

Johnson D, Diehn R, Giannini R, et al. Genetically defined oligodendroglioma is characterized by indistince tumor borders at MRI.  American Journal of Neuroradiology. 38(4):678. Doi:10.3174ajnr.A5070.

Wu Jianlin, Tarabishy B, Hu Jiani, et al. Cortical calcification in sturge-weber syndrome on MRI-SWI: relation to brain perfusion status and seizure severity. J Magn Reson Imaging. 2011 Oct:34(4):791-798.

another ct of an oligodendroglioma