IMMOBILISATION AND COGNITIVE DECLINE IN BRAIN INJURY - CALCIUM THE CONNECTING LINK

Immobilization hypercalcemia (IH) is a rare entity. It is seen in patients with long term immobilization, like spinal cord injury or long bone fracture, particularly in children and adolescents. Here we report a case of Immobilization hypercalcemia in a patient with Brain injury, which was clinically unnoticed and later presented with complications, which has significant impact on the cognition and affects neurological recovery. The exact pathophysiology of immobilisation related hypercalcemia is yet unknown, but rapid bone turnover is supposed to be involved in the process.We report a case of Immobilization hypercalcemia in a patient one year after traumatic brain injury. During the hospital stay, the patient had an episode of seizure. Routine blood investigations were normal except for high calcium levels. Further investigations revealed low parathyroid hormone, normal 1,25-dihydroxy vitamin D and high 24-hour urinary calcium. He was diagnosed to have IH after ruling out all other causes of hypercalcemia. Treatment is targeted to wards lowering the serum calcium level by early mobilisation and exercises, intravenous hydration with isotonic saline, frusemide, Calcitonin, Bisphosphonates which are conventional therapies. Newer treatment options include receptor activator of nuclear factor kappa-B ligand (RANKL) inhibitor, denosumab. Physicians dealing with long term bed ridden patients should keep this as a differential diagnosis which helps in avoiding unnecessary investigations chasing the aetiology, annoying recurrences and preventing life threatening complications.