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A 63-year-old woman with advanced chronic kidney disease, diabetes mellitus, hypertension and peripheral vascular disease presented with three successive tonic–clonic seizures. She was obtunded, with a Glasgow coma scale score of 4/15 but with no lateralising neurological signs. She had marked renal impairment (serum creatinine 606 µmol/L (49–90) and estimated glomerular filtration rate of 6 mL/min/1.73 m2 (>60)). There was severe hyperparathyroidism (parathyroid hormone 48.8 pmol/L (1.7–7.6)).
CT scan of the head found widespread infratentorial and supratentorial calcifications, unchanged from a CT scan 2 years before, and subtle acute subdural and subarachnoid haemorrhages (figure …
Contributors HR had the original idea for the manuscript, identified the images for publication and helped with the preparation of the manuscript. SWL wrote the initial draft of the manuscript and the subsequent modifications and prepared and labelled the images for publication.
Competing interests None.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed. This paper was reviewed by Tom Hughes, Cardiff, UK.