Abstract
Fahr's syndrome is a rare neurological entity, primarily impacting basal ganglia with bilateral intracranial calcium deposition. It mainly manifests motor and psychiatric symptoms in affected individuals. After the patient and her family members' consent and proper ethical clearance from the institutional ethical committee, we here report a case presented with a few motor symptoms, features of delirium, and prominent psychiatric symptoms such as disorganized behavior, auditory hallucinations, and delusions. The imaging study found bilateral basal ganglia calcification and edema in the parietal region, primarily on the right side. Laboratory studies revealed mildly low parathyroid hormone and calcium levels, but no significant findings in other investigational tests. Her past medical and psychiatric history were negative, except for her well-adjusted pre-morbid personality. Our aim through this case is to highlight the psychiatric manifestation of a rare neurological syndrome. It also showcases the importance of ruling out medical causes when a patient presents primarily with behavioral symptoms.
Highlights
Fahr's syndrome is characterized as a rare neurological condition that primarily impacts basal ganglia through its calcification [1]
About 40% of patients with basal ganglia calcification may present with psychiatric symptoms from mania, apathy, or psychosis
A study by Ramis et al determined the disturbance in the calcium and phosphate metabolism in this rare neurological disorder, which leads to hypocalcemia and hypoparathyroidism [7,8]
Summary
Fahr's syndrome is characterized as a rare neurological condition that primarily impacts basal ganglia through its calcification [1]. A 33-year-old Asian Indian female was brought by her mother to the psychiatric outpatient services Her medical complaint includes diffuse headache, abnormal behavior, reduced sleep, jerky movements in the left lower limb, decreased appetite, paranoid behavior, and auditory hallucinations. Patient electrolytes abnormalities were rectified by fluid therapy, which resulted in the improvement of her delirium Her agitation and restlessness were present on the third inpatient day evening with no signs of delirium. The patient was found febrile on her ninth day of admission, and acetaminophen 500 mg was started immediately on a pro re nata (PRN) basis Her fever subsided, but her tremors, agitation, auditory-hallucinations persisted. The patient's auditory hallucinations were still present on the follow-up visit with rest symptoms of delusion, agitation, tremors improving as reported by parents. The patient did not report, and family members informed through telepsychiatry consultation that the patient reported only 10% to 15% improvements in her hallucinations and headache; her agitation, delusion, tremors subsided as reported
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