World Journal of Medical Sciences 20 (3): 47-62, 2023

ISSN 1817-3055
© IDOSI Publications, 2023
DOI: 10.5829/idosi.wjms.2023.47.62

Magnitude of Intracranial Calcifications, Their Association with

Body Mass Index and Anatomical Sites Involved Among Adults in
Two Tertiary Level Hospitals in SNNPR Ethiopia: 2022 (Cross Sectional Study)

Yilma Keltu

Wolaita Sodo University, College of Health Sciences and Medicine,

Department of Clinical Anatomy, Sodo, Ethiopia

Abstract: Background: Intracranial calcification is specifically calcium or calcium compounds deposition within
cranial cavity in a brain tissue and or associated structures. Calcification is mineral deposition of any of body
tissues notably soft tissue rendering it hard and solid. Unless physiological calcifications which not known to
bring health related problem, pathological intracranial calcifications are tremendously notorious cause
cognitive, motor, memory, autonomic as well as sensory system diseases and disabilities in affected patients.
Objective : The objective of this study was to assess association between intracranial calcifications and their
prevalence in two tertiary level health care institutions in SNNPR, Ethiopia. Adult patients who attend these
facilities to get CT scan of head. Methods and Materials: The study conducted in two tertiary level healthcare
institutions in Wolaita zone, SNNPR of Ethiopia, namely Wolaita Sodo Christian General Hospital and Wolaita
Sodo University Teaching and Referral Comprehensive Hospital, which are currently making active use of CT
scan for diagnosis of various causes. A systematic sampling technique was used to recruit the predetermined
sample size of n = 403. Before the selection of study participants, proportion to size allocations of the sample
size for the number of adults undergone CT scan of head in each health institution was performed. Structured
questionnaire was prescribed by trained data collectors to get data and Subsequent measurements of height
and weight of patients obtained. Data was entered into Epi-data software version 4.4.2.1 and then exported to
SPSS version 25 statistical package for analysis. The results are summarized in the form of proportions and
frequency tables for categorical variables. Correlation coefficient and odds ratio calculated statistically.
Continuous variables Summarized using means, median and standard deviation. P-values computed for
categorical variables using Chi-square ( 2) test and p value of P<0.05 was taken as a statically significant.
Results: The overall magnitude of intracranial calcification was 28.3%. Older age (AOR=3.260, 95% CI;
1.671-6.361), Hypertension (AOR=2.353, 95% CI; 1.130-4.901), Kidney disease (CKD) (AOR=2.611, 95% CI;
1.260-5.410), Diabetes Mellitus (AOR=2.523, 95% CI; 1.170-5.442), Stroke (AOR=3.247, 95% CI; 1.053-10.015) and
BMI of patient ( 25.0 kg/m2; AOR=3.247, 95%CI; 1.004-11.202) were significantly associated factors with the
ICC formation in brain. Conclusion and recommendation: This study found a magnitude of intracranial
calcifications of 28.3% among adults whom underwent CT scan imaging diagnosis of head in WSCGH and
WSUTRH for various reasons. Factors that contribute to intracranial calcifications were older age,
hypertension, kidney disease (CKD), Diabetes mellitus, Stroke, hemiplegia or paraplegia and higher body mass
index level (BMI).

Key words: Body Mass Index CT scan Intracranial Calcification Obesity

INTRODUCTION requirements organism needs to survive. Brain and

spinal cord constitute central nervous system while
In highest order animals like mammals and spinal nerves constitute peripheral nervous system.
vertebrate, nervous system is highly specialized Physiologically or functionally nervous system further
system owing to its intricate functional and structural divides into various categories predominantly being

Corresponding Author: Yilma Keltu, Wolaita Sodo University, College of Health Sciences and Medicine,
Department of Clinical Anatomy, Sodo, Ethiopia.
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classified as autonomic and somatic nervous system used as important augments to available imaging
depending on control of activities made voluntarily or modalities. Intracranial calcifications are a common
involuntary [1]. radiographic finding and their pathogenesis varies from
Since it is prominently exposed part of body in benign physiological processes to multiple pathological
humans and some other animals, head is primarily subject processes, their imaging characterization according to
to multitude of traumas and injuries that have potential to their morphology and location is important to establish a
bring damage to the brain. Furthermore, its confinement proper differential diagnosis [7].
within limited area (cranial cavity), which cannot tolerate Although the process of calcification is not clearly
any increase in mass or pressure that arise due to either understood currently, according to many research
pathological or physiological or traumatic processes findings the underlying cause is closely associated
makes it vulnerable when compared to other parts and with both physiological and pathological metabolic
structures of human body. An abnormal involvement of processes. Metabolism of proteins, fats and
little area of brain in cranial cavity or spinal cord and carbohydrates plays significant role in the process of
spinal nerves in spinal cavity can end up in profound formation of calcification apart from cellular calcium
dysfunctions [2]. metabolism dysfunction [6, 8, 9].
Factors that yield to functional and/or structural Association of ICCs with nutritional status of body
disruptions of nervous system in general and the central and metabolic processes of nutrients, trace minerals,
nervous system in particular are related to causes that vitamins and their oxidative respiration is currently
affect the size of brain tissue and pressure of intracranial ongoing research. Physiological processes of calcium
cavity. Neoplasms, inflammations, infections, fluid and storage and utilization is a major issue surrounding
blood accumulations and calcifications are frequent calcification formation. Along with other minerals which
causes of both anatomical and physiological are important to normal functioning of organisms, calcium
dysfunctions [3]. metabolism is to large extent subject to hormonal control.
Due to the fact that the involvement of small area of Either hormonal physiological dysfunction in association
brain by any lesion including different forms of with excess amount of calcium in the body can lead to
calcifications results in profound effect in the normal deposition of calcium in tissues. To the best of our
functioning of nervous system in form of either motor or knowledge, for instance, Hypoparathyroidism is well
autonomic nervous system functioning. Notable areas of known phenomena in calcification formation [6, 9, 10].
brain that can result in gross dysfunction of coordination, Abnormal nutritional status either in form of shortage
cognition and memory include basal ganglia, limbic or excess of nutrients is implicated as known cause of
system [4]. many diseases. Even though association between
Calcification is mineral deposition in any of body nutritional status of an individual and calcification
tissues notably in soft tissue rendering it hard or solid. formation is got some concern among researchers and
Intracranial calcification is specifically calcium or calcium academicians, there is no definite causation concept.
compounds deposition within cranial cavity involving Findings of some studies are even conflicting and
brain tissue and or associated structures. Calcifications paradoxical [11, 12].
that take place external to cranial cavity are called Health associated risks of malnutrition (under
extra-cranial calcifications and those which occur within nutrition and over nutrition) are common theme in current
cranial cavity are called intracranial calcifications [5, 6]. scientific community. Over nutrition is as equally as
Calcification of tissues can be physiological or health damaging as under nutrition, coupled with modern
pathological. Physiological calcifications commonly lifestyle. The role of obesity as contributing factor for
include calcification of pineal gland, habenicular, basal intracranial and extra cranial tissue calcification formation
ganglia and choroid plexus [6]. is thus being equally viewed to its contribution to
The emergence of rapid and effective diagnostic diseases like diabetes mellitus and hypertension among
imaging instruments made the study of intracranial others [13, 14].
calcifications whether they are physiologic or pathologic This current study assessed the association of ICCs
relatively easy. Computed tomography (CT) is standard formation and nutritional status of adults. Nutritional
imaging instrument in diagnosis and characterization of status is commonly assessed and categorized by world
intracranial calcifications. Magnetic resonance imaging health organization (W.H.O) standardized body mass
(MRI) though not effective as CT scan for study and index (BMI) scale. BMI is technically feasible, easy to
diagnosis of intracranial calcification, it has frequently understand tool used to assess nutrition status among

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humans even though it is inferior to standard laboratory 2008 to 2012. According to USA statistics, there is one
biochemical tests. Despite its shortcomings, BMI is being ASD patient in every 68 adults. In a recent study in
widely employed for various purposes in connection to Sri Lanka, being a developing country, it is found
health care planning and intervention as well as to that 10% of the children involved in the study are
decision and policy making. suffering from ASD. Another study shows that 1 in every
93 children are affected by ASD in Sri Lanka [19, 20].
Statement of Problem: Globally, the prevalence and Thus, it requires special attention, awareness and
associated health consequences ascribed to intracranial treatments of neurological disorders. Some of these
calcifications tend to differ from one area to another disorders are mostly encountered in children and
significantly. Periodic reports of world health organization continuing to adulthood that can be a lifelong health
(W.H.O) indicate that neurological disorders and diseases problem. Coupled with comparatively shorter access to
are escalating from time to time. Some forms of intracranial diagnosis and treatment of neuropsychiatric related
calcifications are intimately related to diseases like morbidities and disabilities, developing and under
Alzheimer’s, dementia and Parkinsonism. Alzheimer’s developed world is under growing need of solution to the
disease (AD) is a globally common neurodegenerative situation [8, 21].
disease, which is accompanied by alterations to various Intracranial calcifications that involve some specific
lifestyle patterns, such as sleep disturbance. Some forms areas of brain are known to cause significant diseases and
of ICCs (e.g., bilateral basal ganglia calcifications) are disabilities. In adults, most commonly occurring
known to culminate in Alzheimer’s disease eventually morbidities and disabilities, that affect motor, memory,
[6, 15, 16]. cognition and autonomic functioning are Parkinsonism,
Increasing trends of Neurological and mental migraine, dementia and ataxia among others. Dementia, for
health cases that arise from diverse etiologies put major instance, is a common manifestation with 46.8 million
threat to the health and wellbeing of global population. people having this condition worldwide. Dementia mostly
Neurological disorders contribute to 92 million disability- appears to result from a combination of factors, including
adjusted life years (DALYs) in 2005 projected to increase Alzheimer disease (AD), vascular lesions, Lewy bodies
to 103 million in 2030 (approximately a 12% increase), and inflammation, which eventually lead to atrophy of the
with intracranial calcified lesions contributing its share to cortex and hippocampus [22, 23].
the problem. While Alzheimer and other dementias are World Health Organization (WHO) Reported in 2001
projected to show a 66% increase from 2005 to 2030, [17], figures that show that four of the ten leading causes
there is an estimated 57% decrease in DALYs associated of disability worldwide are neuropsychiatric disorders,
with poliomyelitis, tetanus, meningitis and Japanese accounting for 30.8% of total disability and 12.3% of the
encephalitis combined. Neurological disorders included in total burden of disease. This latter figure (disability) is
the neuropsychiatric category contribute to 2% of the expected to rise to 15% by the year 2020. Tumors had 40
global burden of disease, while cerebrovascular disease %, vascular lesions had 6% and pathological bilateral
and some of the Neuro-infections (tetanus, meningitis and basal ganglia had 4% and congenital phacomatoses in 2%
Japanese encephalitis) contribute to 4.3% of the global of patients [17].
burden of disease in 2005. Thus, neurological disorders On the other hand, obesity that roots from in advert
constitute 6.3% of the global burden of disease [15, 17]. dietary habit currently the major challenge causing a
Intracranial calcifications are directly and indirectly number of both short and long-term health problems. It is
participated in a range of both neuropsychiatric and in obese and chronically hypertensive and diabetic
autonomic dysfunctions. Disorders such as autism individuals that most of occlusion of blood vessels
spectrum disorder (ASD), Alzheimer Disease, downs occurs due to calcification of arterial walls. Intracranial
syndrome, Attention-Deficit Hyperactivity Disorder blood vessel calcification is the major challenge today.
(ADHD), cerebral palsy, Sickle Cell Disease (SCD), The prevalence of overweight was higher, 22.6% in
depression, dyslexia and anxiety are more prevalent. studies published since 2015, 22.4% in studies conducted
Neurological disorders directly affect the brain and nerve only in urban settings and 24.4% in studies with small
system and causing development disabilities, which has sample size ( 384participants). Similarly, the prevalence of
become one of the major health issues worldwide [15, 18]. obesity was 6.9% in studies published since 2015, 6.2% in
World statistics have shown that 9.4% of children have studies conducted only in urban settings, 6.4% in
diagnosed with ADHD in 2016. The rate of ADHD institution-based settings and 9.6% in studies with small
affected children has increased by more than 50% from sample size [24, 25].

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Apart from things mentioned above, there are no only limited to affect pineal gland and choroid plexus,
sufficient researches nationally (in Ethiopia) that which the study in Addis Ababa Tikur Anbessa hospital
conducted to assess neither magnitude nor prevalence only addressed the incidence of these two structures and
of ICCs and associated factors. Studies conducted omitted other intracranial structures like basal ganglia,
elsewhere tried to assess the association between ICC Habenula and hippocampus [26].
and factors associated but they didn’t included BMI Generally speaking, there is paucity of data and
as candidate factor. One study conducted in Addis literature regarding magnitude of intracranial calcifications
Ababa Tikur Anbessa teaching hospital in Ethiopia [26]. and its association with BMI in our setting. Other factors
This study had stressed on the incidence of occurrence that were indicated and identified by scientific literatures
of pineal gland and choroid plexus but failed to report to have association with ICCs were also assessed.
overall magnitude of ICCs in our setting and the study Establishing magnitude, pattern and association of ICCs
didn’t addressed factors associated with ICCs, including with BMI is necessary to device preventive and
BMI [26]. diagnostic measures. Comparison also made with existing
Present study assessed the association between literature. Feedback information to governmental and to
BMI and ICC, other associated factors and common concerned bodies will be given which, in turn, will help for
sites of occurrence of ICCs in adults. The results of this policy revision and inclusion of ICC related health risks in
study will shed light on mentioned gaps and will add medical routine and to seek early medical attention in case
relevant information to scientific community as whole. of neurological signs and symptoms of disease. In advert
The resultant findings of the study hoped to establish nutritional culture that leads to obesity and eventual
overall magnitude of ICCs thereby allowing comparison health risks will be condemned based on the results of
with other past research findings conducted elsewhere. study if any. Screening means, differential diagnoses to
rule out suspected neuropsychiatric cases will benefit
Justification of Study: Intracranial calcifications that tend from the study by giving new insight to clinicians,
to be pathologic can cause significantly disabling scientific as well as academic society.
diseases. Diagnosis and treatment of associated diseases Therefore, it is of paramount importance if
is relatively costly in many developing countries association of ICCs and BMI and other associated factors
including Ethiopia. Adequate scientific information are studied and identified for diagnostic and clinical
regarding the situation including its prevalence and intervention, including anatomical sites affected by ICCs
pattern of occurrence and association with other factors to provide information to all concerned.
is important to establish preventive and diagnostic
as well as screening measures. In addition to this, Objectives of the Study
non-recommendable nutritional health in the form of General Objective: To assess the magnitude of
underweight and overweight currently one of major intracranial calcifications and its association with body
causes of chronic diseases both in developed and mass index among adults attending two tertiary level
developing countries. health care facilities in SNNPRS Ethiopia, 2022.
Intracranial calcifications have their own share of
causing neurological diseases that involve motor, Specific Objectives:
cognitive, memory, as well as disorder of autonomic To determine the magnitude of intracranial
functions. Information on true magnitude of ICCs plus calcifications among adults attending two tertiary
factors associated with ICC formation is important to level health care facilities in SNNPRS Ethiopia, 2022
measure impact of ICCs on neurological and mental health To assess association between intracranial
diseases. It is also mandating issue to find out magnitude calcifications and body mass index among adults
of ICCs in our setting, which in turn, will be valuable to attending two tertiary level health care facilities in
concerned bodies like clinicians, academicians and SNNPRS Ethiopia, 2022
general public as well. To identify factors associated with ICC among adults
Previous studies conducted on association between attending two tertiary level health care facilities in
ICCs and nutritional status (indirectly with BMI) is very SNNPRS Ethiopia, 2022
few in number. Thus, it is necessary to conduct present To establish frequent sites affected by intracranial
research in order to support, challenge or to compare with calcifications among adults attending two tertiary
findings of past studies. Intracranial calcifications not level health care facilities in SNNPRS Ethiopia, 2022.

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METHODS AND MATERIALS Study Population: All patients who underwent CT scan of
head in Wolaita Sodo Christian General Hospital and
Study Setting Characteristics: Sodo Christian general Wolaita Sodo University comprehensive teaching and
hospital (SCGH) is located at Sodo town, capital the city Referral Hospital during study period and fulfill the
of Wolaita Zonal administration, which is 320 Kilometers inclusion criteria were taken as study population.
south of Addis Ababa (capital city of Ethiopia). SCGH is
a general hospital that has 144 beds in four wards mainly Inclusion and Exclusion Criteria
surgical, maternity and medical and pediatrics and Inclusion Criteria: Patients above age of 18 (adults)
orthopedics. The hospital also has an emergency, whom underwent CT scan of head in the mentioned health
outpatient, optometry and dental clinic. facilities.
Wolaita Sodo University Comprehensive Teaching
and Referral Hospital (WSUCTRH) is located in Wolaita Exclusion Criteria:
Sodo capital city of Wolaita Zone in SNNPR, 125 km away Patients with Glasgow coma scale less than = 8.
from Hawassa Capital city of SNNPR and 320 km to south Non ambulatory patients/bed ridden patients
from Addis Ababa capital of Ethiopia. The hospital has Cases with unidentified findings and artifacts in CT
catchment of 2 million residents and has 195-bed capacity. film
There is one government hospital, 2 private hospitals,
four health centers and many private higher and medium Sample Size Determination: Due to lack of literature
clinics in the town. results on the same topic area (association between ICC
Currently, the hospital serves as a main referral center and BMI), p value of 50% (P=0.5) was taken.
for the Southern part of Ethiopia serving about 10 million By using Table (1), the sample size of this study was
calculated as
people in the region and surrounding areas. The hospital,
which currently has 195 beds went operational since
2
1960s’ and was affiliated to the Wolaita Sodo University.  a 
 Z (1 − )  × p × (1 − P) (1.96) 2 × 0.428 × (1 − 0.428)
2 
Services delivered by organizing are arranged = in to four n = = 384
major departments: Medical, Surgical, Pediatric and d2 (0.05) 2
Gynecology and Obstetrics departments and other clinics
where; n = required sample size d = margin of error 5%. P
like TB-HIV care unit, ART (Anti-Retroviral Therapy)
= proportion of prevalence of ICC = 0.50, Zá/2 critical
clinic, Volunteer counseling and testing (VCT),
value for 95% confidence level which equals to 1.96,
ophthalmology unit, surgical and medical emergency unit,
considering 5% non-response rate (19) added on n,
radiology unit, Intensive Care Unit (ICU) unit and
therefore the final sample size was:
Anesthesiology unit.
According to the hospital annual and monthly report, n = 384 + 19 = 403.
the hospital has about 400 up to 500 daily outpatient
visits on average, including approximately 70 daily Sampling Method: At the beginning the total average
radiology visits of 30 to 40 cases visiting CT scan imaging of adults (1775) who have been underwent for CT scan
room. The radiology department gives services in three of head in one month in two institutions were
main categories. Totally, there are about three specialized identified: Wolaita Sodo Teaching and Referral
professionals and five midlevel personnel in radiology Hospital (994), Wolaita Sodo Christian General
department to provide radiologic services for the clients. Hospital (781). A systematic sampling technique was
used to recruit the predetermined sample size (403).
Study Period: This study was conducted from June 2021 Before the selection of study participants, proportion to
to August 2022. size allocations of the sample size for the number of adults
undergone CT scan of head in each health institution was
Study Design: Facility based cross sectional study was performed. Finally, from the list, the required number
conducted
Table 1: Sample size calculation for magnitude of intracranial calcifications
Source Population: All patients who underwent CT scan in adult patients whom underwent CT scan of head in two tertiary
of head in Wolaita Sodo Christian General Hospital and level health care facilities in SNNPR 2022

Wolaita Sodo University comprehensive teaching and Confidence interval Proportion Power of study Margin of error

Referral Hospital. 95% 0.50 80 5

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Fig. 1: Schematic representation of sampling technique for patients who underwent CT scan of head in two tertiary level
health care institutions in SNNPRS, Ethiopia 2022. [6]

(n=403) of target adults were selected using systematic measuring tape. Data collectors thoroughly oriented with
sampling technique by using interval (Kth) calculated from interview questions, measuring instruments,
radiology data base in one month that divided for the measurement, Sampling and data collection. Two data
number of allocated sample to the health facilities which collectors (at each Hospital) have collected data and one
was 4 (four) intervals from each sample unit. Then the Advisor assigned to assist and to supervise the research
study unit was selected every four (4) intervals for work at the time of data collection.
face-to-face interview.
Data Collection Procedure: Data was collected using
Study Variables: Dependent variable structured and pretested interviewer administered
Intracranial calcification (Yes or No) interview. The questionnaire consists of socio
demographic characteristic and medical history
Independent variables information of participants illegible to inclusion
Age criteria. Each selected study participant interviewed
Sex face to face before taking anthropometric measurements.
Height Radiologists in both hospitals read and ensure the
Weight findings of CT scan film soon after imaging process.
BMI When appropriate, clinical records of patients were
Obesity reviewed specially for patients with diagnosed chronic
Drug use diseases. Radiologists read and interpreted CT scan films
Diseases after imaging. Then data collectors conducted appropriate
Ethnicity measurements with standardized measuring instruments.
Socio-economic status, Marital status, educational Before measuring weight and height of selected
status participants, precise calibration of weighting scale and
height measuring tool (measuring-tape) performed.
Data Collection Method and Procedure Shoes and clothing of selected respondents that likely to
Data Collection Method and Tool: The questionnaire that affect measured values were avoided. The resultant
assesses basic information and socio-demographic figures of measurements were rounded to next near digit.
variables was adopted from previous literatures and
formulated depending on general objective. The imaging Data Quality Control and Management: To maintain data
tool at both institutions was CT scan machine of model quality, two days training was given for data collectors
GE 64 SLICE 2020. Height and weight were measured by and supervisors before data collection. Properly designed
precisely calibrated standard weighting scale and interview data collection materials and data extraction

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checklist developed including instrumentation and categorized underweight, BMI 18.5-24.9kg/m2 is category
measurement. Senior radiologists read and ensure the normal weight and BMI of 25.0kg/m2 is category of
findings of CT scan film. Supervision was carried out on overweight and obese.
daily basis to check completeness, consistency and
outliers both by the supervisor and the principal Obesity: literally refers to fatness (overweight and
investigator to assure the quality of data. Clinical records obesity) of an individual but technically body mass index
of patients were checked and recorded if the need arises. greater than 25.0kg/m2.
Furthermore, head CT scan images of patients was
reviewed from image gallery database by the radiologist CT Scan: Computed tomography scan (advanced,
when necessary. Pretest was performed in 5% of patients minimally invasive radiologic imaging with 3D
prior to the actual data collection time and all necessary visualization of internal organs and structures, but
correction was carried provided necessary. contrast depending on type of tissue).

Data Analysis and Interpretation: After data collection Ethical Consideration: Ethical approval and clearance
completed, data was entered into Epi-data software were obtained from Arbaminch University School of
version and then exported to SPSS version 25 statistical Medicine and Health science ethical review board.
package for analysis. Descriptive statistics were done and Permission to undertake the study was taken from the
summarized by tables, frequencies, percentage, graphs, officials of health care facilities. Corresponding letters
mean and standard deviation, median and interquartile were written to concerned radiologists and staffs involved
range. in radiology unit of both institutions regarding their
Binary logistic regression analysis was used to cooperation and collaboration. Interview was carried out
assess the association between ICC and risk factors. after getting written consent of the Person being
Bivariate logistic regression analysis was performed interviewed. Before each interview, clear explanation was
between dependent and each of the independent given about the aim of the Study. Each respondent was
variables, in sequence. Variables having a p-value of <0.25 assured that the information provided by would be
in bi-variable logistic regression analysis were a potential confidential and used only for the purpose of research.
candidate for multivariable logistic regression analysis to Any participants who are not willing to participate in the
control confounders in regression models. Variables study were never forced to participate. They informed that
having a p-value of less than 0.05 in the multivariable all data and sample obtained from them will be kept
logistic regression model were considered as statistically Confidential by using codes instead of any personal
significant. The final model fitness was checked by identifiers and is meant only for The purpose of the study.
Hosmer and Lemeshow chi-square test with non-
significant p-value (p-value 0.39). The strength and Dissemination of the Results: The finding of this study
significance of association between the outcome variable will be presented during thesis defense and the result will
and independent variables were reported by using the be submitted to Arbaminch University School of medicine
adjusted odds ratio with 95% CI. department of clinical Anatomy. Besides, the findings of
the study will also be submitted to both of health facilities
Operational Definitions where this study was conducted and disseminated
Calcification: Deposition of calcium or calcium through publications and presentations in scientific
compounds in body tissue rendering it hard. conferences and workshops.

Intracranial Calcification: Deposition of calcium or RESULTS

calcium compounds within cranial cavity (brain). In
present study, calcified lesion or body of diameter greater Socio Demographic Characteristics: This research was
than two millimeter was considered as ICC. conducted on 403 participants from two tertiary level
hospitals in southern Ethiopia namely, Wolaita Sodo
Body Mass Index: Indirect measurement or assessment of University Comprehensive Teaching and Referral Hospital
national status in children and adults which is ratio of (WSUTRH) and Sodo Christian General Hospital
weight in kilograms divided by square of height in meters (WSCGH). Fortunately, all the study participants (403)
of the individual. Body mass index of <18.5kg/m2 is are responded (interviewed) making response rate of

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Table 2: Socio-demographic characteristics of patients underwent CT scan of head in two tertiary level health care institutions in SNNPRS, Ethiopia 2022
Variables Category Frequency (n=403) Percent (%) Remark
Age 18-35 124 30.8
36-55 157 39.0
>55 122 30.3
Sex Female 184 45.7
Male 219 54.3
Marital status Single 137 34.0
Married 217 53.8
Widowed 38 9.4
Divorced 11 2.7
Educational status Primary 65 16.1 Meaning level completed
Secondary 136 33.7 N.F.E: No Formal education
Diploma 97 24.1
Degree 61 15.1
Masters and above 10 2.5
N.F.E 23 5.7
Other 11 2.7
Religion Orthodox 121 30.0
Catholic 95 23.6
Protestant 161 40.0
Muslim 26 6.5
Ethnicity Wolayta 183 45.4
Sidama 46 11.4
Gurage 26 6.5
Amhara 22 5.5
Oromo 27 6.7
Other 99 24.6
Occupation Civil servant 88 21.8 Current job (at time of interview)
Merchant 66 16.4
Farmer 62 15.4
Student 27 6.7
Self employed 83 20.6
N.G.O 9 2.2
Unemployed 17 4.2
Other 51 12.7
Residence Rural 153 38.0 At least 6 months of stay
Urban 250 62.0

100%. The normality of age was checked by histogram (30.0%) were found to be followers of Orthodox
and it is skewed to the right; the median (IQR) age of the Christianity; 95 (23.6%) are Catholic adherents, 161
respondents was 43 (57-33 years). Among a total, 219 (40.0%) are Protestant Christianity practitioners and the
respondents (54.3%) were Males and the rest 184 remaining 26 (6.5%) are Muslim by religion.
respondents (45.7%) were Females. Married participants Occupational detail or job profile of the research
account for 217 (53.8%) of study participants. Participants respondents consisted of 88 (21.8%) civil servants, 66
educational status was composed of Primary school (16.4%) individuals are merchant and 62 (15.47%) are
completed 65 (16.1%), Secondary school completed 136 engaged in farming. Unemployed respondents are 17
(33.7%) and those who holding Diploma were 97 (24.1%). (4.2%) out of 403 subjects, 83 (20.6%) respondents are
Ethnic and Religious composition of study self-employed; nine (2.2%) of study participants and the
respondents comprised of 183(45.4%) Wolaita, 46 (11.4%) rest 51 (12.7%) are engaged in NGO and other various job
Sidama, 26 (6.5%) Gurage, 22 (5.5%) Amhara; and 27 types respectively.
(6.7%) of Oromo were ethnic group. The rest 99 (24.6%) With regard to Residence, 153 (38.0%) and 250
respondents out of 403 study subjects contributed from (62.0%) participants are dwellers of urban and rural
all other ethnic groups. Out of 403 study participants, 121 community respectively at the time of interview (Table 2).

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Table 3: Health related behaviors of patients underwent CT scan of head at Wolaita Sodo University Comprehensive Teaching and Referral Hospital
(WSUTRH) and Sodo Christian General Hospital (WSCGH), SNNPR Ethiopia, 2022.
S.no Variable (Health related behavior) Frequency (n=403) Percentage (%)
1 Smoking Yes 16 4.0
No 387 96.0
2 Alcohol intake Yes 60 14.9
No 343 85.1
3 Physical exercise Yes 9 2.2
No 394 97.8
4 Dietary habit (vegetarian) Yes 12 3.0
No 391 97.0
5 Sleep habit >= 8hrs Yes 368 91.3
No 35 8.7

Table 4: Past medical history of patients who underwent CT scan of head at Wolaita Sodo University Comprehensive Teaching and Referral Hospital
(WSUTRH) and Sodo Christian General Hospital (WSCGH), SNNPR Ethiopia, 2022
Variable Attribute Frequency (n=403) Percentage (%) Remark
Past Admission Yes 106 26.3 More than 2 days of hospital stay
No 297 73.7
Past Surgery Yes 25 6.2 Major surgical operation only
No 378 93.8
Past Radiology Yes 16 4.0 -Includes head and body
No 387 96.0 -Repeats counted
Past traumatic head injury Yes 13 3.2 -requiring admission
No 390 96.8 -skull fracture

Health Related Behaviors of Research Respondents: 41(10.2%) respondents found to have hypertension;
Behaviors that promote or affect health were assessed by another 36(8.9%) individuals have history of Diabetes
using structured questionnaire. Active Smoking and mellitus. Kidney, heart and liver diseases were reported by
Alcohol intake was responded by 16(4.0%) and 60(14.9%) 41(10.2%), nine (2.2%), 13(3.2%) respectively. One (0.2%)
respondents respectively. Similarly, Dietary habit of being patient out of 403 participants have history of
vegetarian was found to be 12(3.0%) participants out of hypothyroidism and 24(6.0%) had Asthma (Table 4).
403-subjects. Nine (2.2%) individuals reported habit of
regular physical exercise. Neuro-psychiatric Disease Conditions among Study
On the other hand, 35(8.7%) of study participants Participants: Neurological and psychiatric diseases like
responded of not having recommended daily amount of epilepsy, chronic headache (e.g. Migraine), Depression,
sleep which is greater than 8 hours per 24 hours. Schizophrenia, Stroke and insomnia sought carefully
through all research respondents. Among them 10(2.5%)
Past Medical History: According to our data, 106(26.3%) had history of repeated epileptic attack, 8 (2.0%)
respondents out of 403 have history of past medical respondents responded history of chronic headache,
(hospital) admission and 25(6.2%) subjects out of 403 12(3.0%) respondents had history of depression and
study participants have history of major surgical 18(4.5%) patients had experienced some form of
operation in past. Past radiological diagnostic test was paraplegia or hemiplegia. Among all study participants,
conducted on 16(4.0%) respondents and 13(3.2%) 20(5.0%) patients have experienced stroke attacks
respondents report history of Head injury or Trauma (Table 5).
(Table 3).
Antropho-Morphological and Radiological Findings:
Chronic Disease and Familial Hereditary Illness History: Physical measurements like height and weight measured
History of chronic (metabolic) and familial hereditary and recorded before CT scan of the selected research
diseases of the participants were assessed across respondents. BMI calculation and corresponding
respondents thoroughly using structured questionnaire. classification made by data collectors, then checked and
Out of total four hundred and three study participants, approved by supervisor (investigator) if need arises.

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 World J. Med. Sci., 20 (3): 47-62, 2023

Table 5: Distribution of chronic (metabolic) and Familial hereditary illnesses among patients who underwent CT scan of head at Wolaita Sodo University
Comprehensive Teaching and Referral Hospital (WSUTRH) Sodo Christian General Hospital (WSCGH); SNNPR Ethiopia 2022.
S. Chronic Diseases Frequency (n=403) Percentage (%) Remark
1 Familial Hereditary diseases Yes 52 12.9 Physician confirmed diagnoses and record
No 351 87.1
2 Hypertension Yes 44 10.9 Physician confirmed diagnoses and record
No 359 89.1
3 Kidney disease Yes 41 10.2 Physician confirmed diagnoses and record
No 362 89.8
4 Heart disease Yes 9 2.2 Physician confirmed diagnoses and record
No 394 97.8
5 DM Yes 36 8.9 Physician confirmed diagnoses and record
No 367 91.1
6 Liver disease Yes 13 3.2 Physician confirmed diagnoses and record
No 390 96.8
7 Endocrine/Hypothyroidism Yes 1 0.2 Physician confirmed diagnoses and record
No 402 99.8
8 Asthma Yes 24 6.0 Physician confirmed diagnoses and record
No 379 94.0

Table 6: Neuro-psychiatric disease conditions among patients whom underwent CT scan of head at Wolaita Sodo University Comprehensive Teaching and
Referral Hospital (WSUTRH) and Sodo Christian General Hospital (WSCGH); SNNPR Ethiopia, 2022
Variable (illness) Attribute Frequency (n=403) Percentage (%) Remark
Epilepsy Yes 10 2.5 confirmed
No 393 97.5
Chronic headache (Migraine) Yes 8 2.0 confirmed
No 395 98.0
Schizophrenia Yes - - confirmed
No 403 100.0
Depression Yes 12 3.0 confirmed
No 391 97.0
Stroke Yes 20 5.0 confirmed
No 383 95.0
Hemiplegia/Paraplegia Yes 18 4.5 confirmed
No 385 95.5

Out of total 403 research respondents included in the Calcifications that occurred in various combined
study who undergone CT scan of head, 114(28.3%) have forms (more than one calcification) are also evident.
got intracranial calcification irrespective of intracranial According to our data, 16(4.0%) of patients have pineal
location and number (in single or combined manner), gland and choroid plexus calcification, 10(2.5%) of
making overall prevalence rate of ICC 28.3%. By number patients have calcification of pineal gland and basal
of calcifications per person, those with only one calcified ganglia. Likewise combined calcifications of both pineal
center on CT scan film are 75 (18.6%) individuals, those gland and Habenula seen in three (0.7%) of respondents,
with two calcifications are 33(8.2%) out of 403 and those choroid plexus and basal ganglia calcified in combination
with three calcifications (persons with three discrete in one (0.2%) of patient.
calcifications) are 6(1.5%). There are no participants with Combined calcifications of three loci in single patient
four or more calcification on CT scan film. Totally 127 were that of pineal gland, choroid plexus and basal
discrete (separate) calcifications are counted (regardless ganglia 5(1.2%) and that of pineal gland, choroid plexus
of involved part/calcifications with diameter greater than and Habenula account 1(0.2%; Table 6).
or equal to 2mm; Figure 2).
BMI Categorization and Distribution among Study
Anatomical Sites Commonly Affected by ICCs: Pineal Participants: Common WHO BMI classification scheme
gland calcification alone was found in 41(10.2%) for adults used to assess BMI of all 403 study subjects.
respondents, Choroid plexus alone is calcified in 20 (5.0%) Among them, those subjects with BMI below 18.5kg/m2
subjects, Basal ganglia calcification found on 12(3.0%) of are 32(7.9%), those with BMI of between 18.5kg/m2-
study participants and that of Habenula is 2 (0.5%) 24.9kg/m2 amount 289(71.7%) and those above BMI of
respondents out of 403. 25kg/m2 are 82(20.3%) respondents (Table 8).

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 World J. Med. Sci., 20 (3): 47-62, 2023

Fig. 2: Magnitude of ICC among patients who underwent CT scan of head at Wolaita Sodo University Comprehensive
Teaching and Referral Hospital (WSUTRH) and Sodo Christian General Hospital (WSCGH), SNNPR Ethiopia,
2022. [26]

Fig. 3: Frequency of ICC involved (calcified) sites within the brain of patients who underwent CT scan of head at
Wolaita Sodo University Comprehensive Teaching and Referral Hospital (WSUTRH) and Sodo Christian General
Hospital (WSCGH), SNNPR Ethiopia, 2022 [26].

Table 7: Frequency of ICC involved (calcified) sites within the brain of patients who underwent CT scan of head at Wolaita Sodo University Comprehensive
Teaching and Referral Hospital (WSUTRH) and Sodo Christian General Hospital (WSCGH), SNNPR Ethiopia, 2022.
S. ICC affected Site Frequency Percent (%) Remark
I ICC YES 114 28.3
NO 289 71.7
1 Pineal gland 41 10.2 *
2 Choroid plexus 20 5.0
3 Basal ganglia 12 3.0
4 Habenula 3 0.7 2 at a time
5 Pineal gland and Choroid plexus 16 4.0 "
6 Pineal gland and Basal ganglia 10 2.5 "
7 Pineal gland and Habenula 3 0.7 "
8 choroid plexus and basal ganglia 1 0.2 "
9 Choroid plexus and Habenula 1 0.2 "
10 Basal ganglia and Habenula 1 0.2 "
11 Pineal gland, choroid plexus and Basal ganglia 7 1.7 3 at a time
12 Pineal gland, Choroid plexus and Habenula 2 0.5 "
13 Choroid plexus, Basal ganglia and Habenula 2 0.5 "

Table 8: BMI categorization and allocation among patients who underwent CT scan of head at Wolaita Sodo University Comprehensive Teaching and Referral
Hospital (WSUTRH) and Sodo Christian General Hospital (WSCGH), SNNPR Ethiopia, 2022
S.N BMI category (kg/m2) Classification Frequency (n=403) Percentage (%)
1 <18.5 Under weight 32 7.9
2 18.5-24.9 Normal weight 289 71.7
3 25.0 overweight and obese 82 20.3

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 World J. Med. Sci., 20 (3): 47-62, 2023

Fig. 4: Distribution and association pattern of ICC and BMI in patients whom undergone CT scan of head in Wolaita
Sodo University Comprehensive Teaching and Referral Hospital (WSUTRH) and Sodo Christian General Hospital
(WSCGH), SNNPR Ethiopia, 2022 [27].

BMI and ICC Distribution Pattern among Study than those of young adult (18-35 years of age) individuals
Participants: Among study participants who are (AOR=3.26, 95%CI; 1.67-6.36).
below BMI of 18.9 (underweight) four (12.5%) of In the same manner, the odds of having ICC were 2.35
participants have intracranial calcification and 77(26.6%) times more likely for hypertensive patients compared with
of participants in normal weight BMI rang (18.9-24.5) their counter parts (AOR=2.35, 95%CI; 1.13-4.90). This
found to have calcification. Similarly, 33(40.2%) study also shown that patients who have chronic kidney
respondents in BMI category of above (pre-obesity to disease (CKD) were 2.61 times more likely to be affected
obesity class iii) class have calcification out 43 by ICC compared to those who have no CKD (AOR=2.61,
respondents (Figure 4). 95%CI; 1.26-5.41).
It is also evident that according to results of the
Association between ICC formation, BMI and Other study, patients with diabetes mellitus (DM) are 2.52 times
Associated Factors: Bi-variable logistic regression more likely to get ICC in comparison with non-diabetic
was conducted to identify candidate variables with a counter parts (AOR=2.52, 95%CI; 1.17-5.44). Those
p-value<0.25. The identified variables with presence of patients diagnosed for stroke attack once or more times in
ICC are: Age, Alcohol consumption, Hypertension, their life are 3.25-fold more likely to have intracranial
Kidney disease, Diabetes mellitus, Stroke, calcification (AOR=3.25, 95%CI; 1.053-10.015).
Hemiplegia/paraplegia and BMI were entered to Body mass index of study participants have also
multivariable binary logistic regression to identify the shown significant association with intracranial
possible association with intracranial calcification. In the calcifications. Adults in obese and overweight BMI
multivariable binary logistic regression analysis, Age of category (BMI =25.0kg/m2) were 3.354 more likely to be
patient, hypertension, Kidney disease, D.M, Stroke attack diagnosed with ICC when compared with those
and BMI were significantly associated factors with participants who are in underweight Body mass index
formation of intracranial calcification. category ( 18.5kg/m2). (AOR=3.247, 95%CI; 1.004-11.202).
This study revealed that, when age increase the Similarly, those study participants with in normal
likelihood of ICC will also increase. Among the patients BMI range (18.5-24.5kg/m2) shown no increased odds
that underwent CT scan imaging diagnosis of head in this of getting intracranial calcification in contrast to
study, those in the age category of above 55 years of age underweight participants (AOR=1.748, 95%CI);
(late adulthood) are 3.26 times more likely to have ICC (0.972-3.144; Table 9).

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Table 9: Bivariate and multivariable logistic regression analysis of ICC formation with predictors for patients who underwent CT scan of head in two tertiary
level health care facilities in SNNPRS, 2022.
ICC
---------------------------------
YES NO COR (95%CI) AOR (95%CI) P-value
1. Age 18-35 19(15.3) 105(84.7) 1 1
36-55 43(27.4) 114(72.6) 1.969(1.192-3.253) 1.759(1.010-3.066) .046
56 52(42.6) 70(57.4) 4.105(2.239-7.527) 3.260(1.671-6.361) .001
2. Alcohol Yes 24(40.0) 36(60.0) 1.874(1.060-3.313) 1.492(0.794-2.803) .214
No 90(26.2) 253(73.8) 1 1
3. Hereditary diseases Yes 21(40.4) 31(59.6) 1.879(1.029-3.433 1.150(0.571-2.319) .695
No 93(26.5) 258(73.5) 1 1
4. HPN Yes 26(59.1) 18(40.9) 4.448 2.328 8.498 2.353(1.130-4.901) .022
No 88(24.5) 271(75.5) 1 1
5. Kidney disease (CKD) Yes 22(53.7) 19(46.3) 3.398(1.760-6.561) 2.611(1.260-5.410) .010
No 92(25.4) 270(74.6) 1 1
6. D.M Yes 20(55.6) 16(44.4) 3.630(1.807-7.295) 2.523(1.170-5.442) .018
No 94(25.6) 273(74.4) 1 1
7. Stroke Yes 13(65.0) 7(35.0) 5.185(2.012-13.361) 3.247(1.053-10.015) .040
No 101(26.4) 282(73.6) 1 1
8. Hemi/Paraplegia Yes 10(55.6) 8(44.4) 3.377 1.298 8.790 1.039(0.298-3.618) .952
No 104(27.0) 281(73.0) 1 1
9. BMI <18.5 4(12.5) 28(87.5) 1 1
18.5-24.9 77(26.6) 212(73.4) 1.854(1.111-3.096) 1.748(0.972-3.144) .062
25 33(40.2) 49(59.8) 4.714(1.513-14.694) 3.354(1.004-11.202) . 049
NB: P-value with “*” shows statistically significant variables.

DISCUSSION differences of the study population might be the

contributing factor for this different percent of the ICC
This study was conducted to assess the magnitude outcomes [6, 29].
of intracranial calcification and associated factors among On the other hand, the prevalence of intracranial
adults who underwent CT scan of head in WSCGH and calcifications reported in present study is lower than the
WSUTRH for various medical conditions. findings of studies that contacted in South Africa (98.2%),
Overall prevalence of ICC with a 95% confidence Iran (50%) and Cameroon in central Africa (56.82%). This
interval was 28.3% (23.8% -32.5%). The finding was might be due to the variation of study participants; and
consistent with the studies conducted in University of the study that carried out in South Africa done on larger
Florida Colleges of Dentistry and Medicine (26.96%), but sample size and on the population entirely much varied
lower than reports of the studies done in University of socio-demographic background. The study of Iran also
Southern California, Los Angeles USA (35.2%) and in employed on the general population including all age
Tikur Anbessa hospital in Addis Ababa which reported groups. Moreover, the study conducted in Cameroon was
the prevalence in terms of pineal gland and choroid plexus consists of few study participants (132) in contrast to our
calcifications of around 72.0% for pineal gland (18.8% in study population of 403 [30- 32].
this study) and 43.3% for choroid plexus calcifications Age is commonly significant variable associated
(11.66% in this study) [26-28]. This perceived difference with ICCs. In this study, it is also evident that odds of
seems to root from background characteristics of study getting ICCs increase with age. It revealed that
population and may be lifestyle of population under participants aged 36 years were 1.762 times more likely
study. to have intracranial calcifications than those aged less
The magnitude of intracranial calcifications reported than 35 years old. Those patients greater than 56 years of
in this study was rather higher than the results of studies age have 3.214-fold probability diagnosed with
conducted in Brazil (17.54%) and Beirut in Lebanon (20%). intracranial calcification than younger adults.
the possible reason in this study might be variation in the This finding is in line with prior research reports as
study population. The study carried out in Brazil also shown by figures of researches of Addis Ababa Tikur
included subjects under eighteen years of age, which are Anbessa Hospital in Ethiopia, Cameroon, South Africa
excluded in this study. In addition to this, life style and Iran [26, 30, 32].

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Hypertensive patients have also elevated risk of studies topic area at least one study stated that BMI
getting intracranial calcifications, as in this study. provides a reasonable estimate of body fat and it is more
They have 2.277 times more likely chance of affected by accurate than skinfold measurement [37]. A major problem
ICCs in comparison to non-hypertensive patients. It is with obesity is the diverse set of health-associated
also indicated in other studies as significantly associated complications it causes including hypertension, diabetes,
with ICC, particularly intracranial arterial calcifications. increased cardiovascular risk and cancer among others.
It well established fact that chronic intracranial micro Another study tried to take into account the effect of
bleeds lead to significant rate in calcification formation. body mass index on brain calcification found minimal
This finding was also reported in previous studies interaction among the two. It is also stated in other
conducted by T.T. de Weert 2009 [33]. literatures that indeed, there is interplay of various
Chronic kidney disease (CKD) patients have metabolic processes on causation calcification in general
2.611 more risk of getting ICC than those did not and intracranial calcification in general though the
have the disease (CKD) (AOR=2.611, 95% CI; 1.260-5.410). process is complex enough to investigate and measure
In France, patients with CKD are mostly affected by [9, 11, 25, 36, 38].
intracranial calcifications [34]. Their finding puts the
risk of ICC in CKD patients as about 2.6 times CONCLUSION AND RECOMMENDATIONS
higher, which is comparable to finding of this study
[35, 36]. This study found that a magnitude of intracranial
Another study published by Romina Maria Uranga calcifications was 28.3% among adults whom underwent
et al. [37], in their paper ‘Complex Interactions Between CT scan imaging diagnosis of head in WSCGH and
Obesity, Metabolism and the Brain’, found that diabetic WSUTRH. Factors that contribute to intracranial
individuals like those affected by CKD are too, have more calcifications were older age, being with hypertension,
risk of getting intracranial calcifications. In this current being with Kidney disease (CKD) and being Diabetes
research, also, the patients of diabetes mellitus are also mellitus, patients with history of Stroke attack, hemiplegia
found to have 2.523 times more chance of having ICC or paraplegia and patients with higher Body mass index
unlike those whom are non-diabetic (COR= 2.523, 95%CI; level (BMI).
1.170-5.442) [35, 36].
Stroke is also one of factors that associated with risk Therefore based on the above conclusions the following
of ICC formation in those affected by it. In this study it recommendations can be forwarded are:
was shown that there is 3.247 times more probability of Health care planners should focus on setting a
being affected by intracranial calcification in comparison strategy that helps for the delivery of information on
to no stroke participants (AOR=3.247, 95CI; 1.053-10.015). the concept of intracranial calcifications. Planning
Works of Romina Maria Uranga et al.[37], also support health education delivery method that informs public
this finding and de Weert et al. [33], reported close on prevention and adequate treatment of chronic
association of ischemic stroke and intracranial (metabolic diseases) and nutritional habits that affect
calcifications predominantly that of intracranial arterial health such as obesity thereby addressing
calcification (IAC) [35, 36]. prevention of intracranial calcifications.
Body mass index (BMI) of adults included in this Health professionals working in both WSCGH and
study also associated with carrying some degree risk of WSUTRH should aware adults as well as other
intracranial calcification. Those adults in BMI category patients to prevent possible factors that predispose
above 25.0kg/m2 were 3.354 times more likely to have intracranial calcification formation including obesity
intracranial calcification in contrast to those below body and other factors discussed in this study. Health
mass index of 18.5kg/m2 (underweight) adults education to prevent chronic metabolic diseases and
(AOR=3.354, 95%CI; 1.004-11.202). Adult study obesity related dangers. Health care professionals
participants with in normal body mass index range also have to screen and diagnose patients at risk
(18.5-24.9kg/m2) have also 1.748 higher risk of intracranial intracranial calcifications. They also should give
calcification formation than those who are underweight. special care in addition to routine care for patients
Even though there are no adequate literatures on this with known risk factors.

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Community health workers should give health 11. Del Brutto, O.H., R.M. Mera and A.P. Investigators,
education at community and household level for 2017. Inverse relationship between the body mass
prevention of occurrences of intracranial index and severity of carotid siphon calcifications
calcifications as well as dangers associated with (another obesity paradox): results from the Atahualpa
improper nutritional habits and avoiding unnecessary Project. Atherosclerosis, 259: 1-4.
weight gain. Awareness creation on early diagnosis 12. Shefer, G., Y. Marcus and N. Stern, 2013. Is obesity a
and treatment of chronic metabolic diseases like brain disease? Neuroscience & Biobehavioral
diabetes mellitus, hypertension, chronic kidney Reviews, 37(10): 2489-503.
diseases (CKD) should be urged. 13. Das, U.N., 2010. Obesity: genes, brain, gut and
environment. Nutrition, 26(5): 459-73.
REFERENCES 14. Raji, C.A., A.J. Ho, N.N. Parikshak, J.T. Becker,
O.L. Lopez and L.H. Kuller, 2010. Brain structure and
1. Mancall ELaB, D.G., 2011. Gray's Clinical obesity. Human Brain Mapping, 31(3): 353-64.
Neuroanatomy E-Book. In: Gray's Clinical 15. World Health Organization (WHO), 2006.
Neuroanatomy [Internet]. Neurological disorders: public health challenges:
2. Rupani, R.V.A. and S. Rathore, 2013. Pattern of skull World Health Organization.
fractures in cases of head injury by blunt force. 16. Wortmannm, M., 2012. Dementia: a global health
Journal of Indian Academy of Forensic Medicine. priority-highlights from an ADI and World Health
35(4): 336-8. Organization report. Alzheimer's Research &
3. Vinters, H.V. and B. Kleinschmidt-DeMasters, 2018. Therapy, 4(5): 1-3.
17. World Health Organization (WHO), 2001. The World
General pathology of the central nervous
Health Report 2001: Mental health: new
system.Greenfield's Neuropathology-Two Volume
understanding, new hope.
Set: CRC Press, pp: 25-82.
18. Al Mane, K., F. Al-Dayel and P. McDonald, 1998.
4. Faehndrich, J., S. Weidauer, U. Pilatus, A. Oszvald,
Intracranial calcification in Raine syndrome:
F. Zanella and E. Hattingen, 2011. Neuroradiological
radiological pathological correlation. Pediatric
viewpoint on the diagnostics of space-occupying
Radiology, 28(11): 820-3.
brain lesions. Clinicalneuroradiology, 21(3): 123-39.
19. Kendall, B. and N. Cavanagh, 1986. Intracranial
5. Livingston, J.H., S. Stivaros, D. Warren and
calcification in paediatric computed tomography.
Y.J. Crow, 2014. Intracranial calcification in
Neuroradiology, 28(4): 324-30.
childhood: a review of aetiologies and recognizable
20. Kiroglu, Y., C. Çalli, N. Karabulut and Ç. Öncel, 2010.
phenotypes. Developmental Medicine & Child
Intracranial calcifications on CT. Diagnostic and
Neurology, 56(7): 612-26.
Interventional Radiology, 16(4): 263.
6. Saade, C., E. Najem, K. Asmar, R. Salman, B. El
21. Guedes, M.d.S., I.C. Queiroz and C.C.d. Castro, 2020.
Achkar and L. Naffaa, 2019. Intracranial calcifications Classification and clinical significance of intracranial
on CT: an updated review. Journal of Radiology Case calcifications: a pictorial essay. Radiologia Brasileira,
Reports, 13(8): 1. 53: 273-8.
7. Raichle, M.E. and M.A. Mintun, 2006. Brain work and 22. Akinyemi, R.O., 2012. Epidemiology of parkinsonism
brain imaging. Annu. Rev. Neurosci., 29: 449-76. and Parkinson’s disease in Sub-Saharan Africa:
8. Taborda, K.N.N., C. Wilches and A. Manrique, 2017. Nigerian profile. Journal of neurosciences in rural
A diagnostic algorithm for patients with intracranial Practice, 3(03): 233-4.
calcifications. Rev. Colomb. Radiol., 28: 4732-9. 23. Loeb, JA., S.A. Sohrab, M. Huq and D.R. Fuerst,
9. Palavra, F., L. Almeida, A. Ambrósio and F. Reis, 2006. Brain calcifications induce neurological
2016. Obesity and brain inflammation: a focus on dysfunction that can be reversed by a bone drug.
multiple sclerosis. Obesity Reviews, 17(3): 211-24. Journal of the Neurological Sciences. 243(1-2): 77-81.
10. Friedman, J.H., M.I. Chiucchini and J.R. Tucci, 1987. 24. Must, A., J. Spadano, E.H. Coakley, A.E. Field,
Idiopathic hypoparathyroidism with extensive brain G. Colditz and W.H. Dietz, 1999. The disease burden
calcification and persistent neurologic dysfunction. associated with Overweight and Obesity. Jama,
Neurology, 37(2): 307-311. 282(16): 1523-9.

61
 World J. Med. Sci., 20 (3): 47-62, 2023

25. D O'Brien, P., L.M. Hinder, B.C. Callaghan and 33. De Weert, T., H. Cakir, S. Rozie, S. Cretier,
E.L. Feldman, 2017. Neurological consequences of E. Meijering and D. Dippel, 2009. Intracranial internal
obesity. The Lancet Neurology, 16(6): 465-77. carotid artery calcifications: association with vascular
26. Admassie, D. and M. Abebe, 2009. Incidence of risk factors and ischemic cerebrovascular disease.
normal pineal and chroids plexus calcification on American Journal of Neuroradiology, 30(1): 177-84.
brain CT (computerized tomography) at Tikur 34. Jean-Marc, B., L. Sophie, D. Pharm and G. Olivier,
Anbessa Teaching Hospital Addis Ababa, Ethiopia. 2018. Cognitive Impairments and Dysexecutive
Ethiopian Medical Journal, 47(1): 55-60. Behavioral Disorder in Chronic Kidney Disease. The
27. Barghan, S., M. Tahmasbi Arashlow and M.K. Nair, Journal of Neuropsychiatry and Clinical
2016. Incidental findings on cone beam computed Neuroscienses.
tomography studies outside of the maxillofacial 35. Bugnicourt, J.M., J.M. Chillon, Z.A. Massy,
skeleton. International journal of dentistry. S. Canaple, C. Lamy and H. Deramond, 2009. High
28. Sedghizadeh, P., M. Nguyen and R. Enciso, 2012. prevalence of intracranial artery calcification in stroke
Intracranial physiological calcifications evaluated patients with CKD: a retrospective study. Clinical
with cone beam CT. Dentomaxillofacial Radiology, Journal of the American Society of Nephrology,
41(8): 675-8. 4(2): 284-90.
29. de Oliveira, M.F., E.B.e Silva and J.R.M. de Oliveira, 36. Neuro, A., 2018. Society for Research in
2015. Prevalence of brain calcifications in a Brazilian Neurosciences.
cohort. 37. Romania Maria, U., N.M. Giusto and G.A. Salvador,
30. Koranteng, P.N., 2016. The prevalence of incidental 2009. Iron-induced oxidative injury differentially
physiological intracranial calcifications in the South regulates PI3/Akt/GSK3â pathway in synaptic
African adult population as seen on computed endings from adult and aged rats. Toxicological
tomography. University of Witwatersrand; Sciences, 111(2): 331-344.
Johannesburg. 38. Aljizeeri, A., A. Lee, S.A. Ghraboghly and B. Chow,
31. Daghighi, M., V. Rezaei, S. Zarrintan and H. Pourfathi, 2013. Can Body Mass Index and Body Surface Area
2007. Intracranial physiological calcifications in as Measures of Obesity Predict Coronary Artery
adults on computed tomography in Tabriz, Iran. Folia Calcification? Canadian Journal of Cardiology,
Morphologica, 66(2): 115-9. 29(10): S304.
32. Uduma, U.F., F. Pius and M. Mathieu, 2012.
Computed tomographic pattern of physiological
intracranial calcifications in a city in central Africa.
Global Journal of Health Science, 4(1): 184.

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