Recurrent syncope and hypocalcaemic cardiomyopathy as manifestations of Fahr’s syndrome C D Figure 1C-D. ECG findings taemia, hypoparathyroidism, hypothyroidism, increased thyroid peroxidase antibodies and thyroglobulin antibodies (Table I). A transthoracic echocardiogram revealed generalized hypokinesis of the left ventricle and systolic dysfunction (reduced ejection fraction: EF = 42%). ECG Holter monitoring did not reveal any abnormalities which could be responsible for the recurrent syncope. No abnormalities of the ST segment typical for ischaemic heart disease were present in ECG Holter monitoring. Computed tomography (Figures 2-5) revealed bilateral, massive calcifications of the cerebellar dentate nucleus and white matter, lenticular nucleus: putamen and globus pallidus, caudate nucleus, thalamus, pons, white matter of centrum semiovale, grey matter of the fundus of fissures in the frontal lobe (superior frontal sulcus), parietal lobe (central sulcus), temporal lobe (superior temporal sulcus), and occipital lobe (calcarine sulcus and parieto-occipital fissure). Electroencephalography did not show any abnormalities. Psychiatric examination revealed depression, anxiety and mild neurocognitive impairment (Mini-Mental State Examination: 23 points – MMSE) [7]. The patient reported depressive mood, apathy, and inability to make decisions, that had developed since one year ago. Finally she was too apathetic to perform daily living activities. Three Table I. Laboratory abnormalities Serum parameter Patient’s result Laboratory norm Calcium Phosphate Parathormone Thyrotropin Triiodothyronine Thyroxine Thyroid peroxidase antibodies (TPOAb) Thyroglobulin antibodies (TgAb) 3.61 mg/dl 7.3 mg/dl 3.39 pg/mol 12.39 µU/ml 3.38 pmol/l 8.52 pmol/l > 600 U/ml 8.5-10.8 mg/dl 2.4-4.5 mg/dl 10.0-70.0 pg/mol 0.27-4.2 µU/ml 3.1-6.8 pmol/l 12.0-22.0 pmol/l 0.0-34.0 U/ml 600.8 IU/ml 0.0-115.0 IU/ml Arch Med Sci 1, February / 2010 119