Intracranial Calcification
Calcium deposits in the brain are surprisingly common and appear in many different forms, ranging from normal age-related changes to signs of serious disease. Understanding these calcifications can help identify their cause and guide appropriate care.
Table of contents
- What Is Intracranial Calcification?
- Types and Causes of Brain Calcification
- How Common Is It?
- Signs and Symptoms
- How It Is Diagnosed
- Primary Familial Brain Calcification
- Treatment Options
What Is Intracranial Calcification?
Intracranial calcification refers to calcium deposits that form within the brain tissue itself or in the blood vessels inside the skull[1]. These deposits appear as bright white spots on brain imaging scans. When calcium builds up in these areas, it hardens and can affect how the brain and its blood vessels work.
The brain contains many structures where calcium can accumulate. The deposits can be tiny, visible only under a microscope, or large enough to be called “brain stones”[4]. Most importantly, not all brain calcifications are harmful. Some are simply part of normal aging, while others signal underlying health problems that need attention.
Types and Causes of Brain Calcification
Brain calcifications can be classified into two main groups: normal (physiologic) and abnormal (pathologic)[1][3].
Physiologic calcifications are normal calcium deposits that develop with age. These commonly occur in structures such as the pineal gland deep in the brain, the choroid plexus (which produces fluid around the brain), and in membranes like the falx cerebri that separate brain sections[1][6]. These deposits typically cause no symptoms and are considered a natural part of aging.
Pathologic calcifications have many different causes. They can result from metabolic and hormone disorders, infections, blood vessel problems, tumors, genetic conditions, inflammation, and exposure to certain toxins[1][3]. The location, pattern, and size of the calcium deposits, combined with a person’s age and medical history, help doctors determine the underlying cause.
When calcium builds up in blood vessels within the brain, it is called intracranial artery calcification. This type is strongly linked to atherosclerosis, a disease where arteries become narrowed and hardened[5]. Research shows this vascular calcification may be associated with increased risk of stroke and problems with thinking and memory.
How Common Is It?
The presence of intracranial calcifications varies greatly by age. Studies show they appear in only about 1% of young people but can be found in up to 20% of elderly individuals[1]. However, when researchers examine brain tissue after death, they find evidence of calcium deposits in up to 72% of cases, with microscopic calcifications being the most common[1].
The widespread use of computed tomography (CT) scans has made it much easier to detect these calcifications. CT scanning remains superior to other imaging methods, including magnetic resonance imaging (MRI), for identifying and characterizing brain calcifications[1][3].
Signs and Symptoms
Many people with intracranial calcification have no symptoms at all[2][10]. When symptoms do occur, they typically fall into two categories: movement problems and psychiatric or behavioral changes.
Movement-related symptoms can include clumsiness, walking unsteadily, slow movements, muscle stiffness, tremors, involuntary movements of the arms or legs, cramped muscles, difficulty swallowing, and slurred or slowed speech[10][11]. Many of these symptoms resemble those seen in Parkinson’s disease, including slow movement (bradykinesia), rigid muscles, and trembling[2].
Psychiatric and behavioral symptoms may include poor concentration, memory problems, mood changes, personality changes, confusion about reality (psychosis), and declining mental function (dementia)[2][10]. Between 20 to 30 percent of people with certain forms of brain calcification experience these types of problems[2].
Other symptoms can include severe headaches, tiredness, migraine headaches, seizures, extreme dizziness (vertigo), loss of bladder control, and impotence[10][14]. The severity and type of symptoms often depend on which part of the brain is affected and how extensive the calcification is.
How It Is Diagnosed
Doctors typically begin by reviewing symptoms and family health history[10]. A CT scan is the most common and effective imaging test for detecting calcium deposits in the brain[1][10]. This test combines many X-ray images to create detailed pictures of the brain’s internal structures. On a CT scan, calcium appears bright white and is easy to identify.
Other imaging tests such as MRI and regular X-rays might also reveal calcium buildup, though CT scanning remains the gold standard[10]. Special MRI sequences, including gradient echo T2* and susceptibility-weighted imaging, can be helpful as additional tools[4].
Blood and urine tests may be ordered to rule out other conditions that could cause similar symptoms or contribute to calcification[10]. In some cases, especially when a genetic condition is suspected, genetic testing may be recommended[10].
The challenge for doctors is determining whether calcification is normal or pathologic. The anatomical location, distribution, size, and shape of calcium deposits, combined with the patient’s age and clinical information, help narrow down the possibilities[3].
Primary Familial Brain Calcification
Primary familial brain calcification is a specific condition characterized by abnormal calcium deposits in blood vessels within the brain[2]. The calcium deposits typically occur in an area called the basal ganglia, which are structures deep within the brain that help control body movement. However, other brain regions may also be affected.
This condition was previously thought to be extremely rare, but recent research suggests it may occur in 2 to 6 per 1,000 people[2]. Many affected individuals show no signs or symptoms, which means the condition is likely underdiagnosed since brain imaging is needed to see the deposits.
Genetic Causes
Primary familial brain calcification is caused by changes (mutations) in one of several genes. The most commonly affected gene is SLC20A2, which accounts for an estimated 40 percent of cases[2][7]. The PDGFRB gene is mutated in about 10 percent of cases[2]. Other genes including PDGFB and XPR1 account for smaller percentages[7][8]. In about half of individuals, the genetic cause remains unknown.
The SLC20A2 gene provides instructions for making a protein that transports phosphate across cell membranes in brain cells. When this gene is mutated, phosphate cannot move properly into cells, causing levels to rise in the bloodstream. In the brain, excess phosphate combines with calcium and forms deposits within blood vessels[2].
The PDGFRB gene controls signaling in cells that line blood vessels. Mutations in this gene may result in too much calcium entering these cells or disrupted regulation of phosphate and calcium levels, leading to calcification[2].
Living with the Condition
Studies of patients living with primary familial brain calcification reveal several common experiences. Many describe shock upon first hearing they have “brain calcification”[14]. Anxiety about passing the condition to children is common, as the disorder can run in families. Patients often express gratitude for family members who provide care and support.
For those with PDGFB gene variants, severe headaches that persist even with pain medication represent the most stressful aspect of the disease[14]. Many patients also report feeling isolated due to having a rare condition that few people understand.
Treatment Options
Currently, there is no cure for pathologic brain calcification[10]. Treatment focuses on managing symptoms and monitoring disease progression. For example, medications can help with anxiety, depression, or mood problems. Anti-epileptic medicines can control seizures, while other medications can prevent and treat migraine headaches[10].
For primary familial brain calcification, symptom management remains the main treatment goal[7][8]. Doctors may prescribe medications to control tremors, headaches, mood swings, and psychotic symptoms. Regular monitoring through annual check-ups helps track whether the condition has changed or advanced[10].
Some research has explored using bisphosphonates, a class of medications commonly used for bone disorders like osteoporosis, to treat brain calcification[7][8]. These drugs bind to calcium crystals and can cross into the brain. A small case series of seven patients treated with the bisphosphonate alendronate showed good tolerance with no side effects, and some patients, particularly younger individuals, appeared to show improvement or stability in their symptoms[7][8]. However, larger, controlled studies are needed to confirm these preliminary findings.
The key to appropriate treatment lies in accurate diagnosis. Since calcification can result from many different causes, identifying the underlying condition is essential. For example, calcifications caused by hormone imbalances may improve when the hormone problem is corrected, while those caused by infections may require specific antimicrobial treatment.