Discussion:
It is essential to emphasize that distinguishing between Fahr’s disease and Fahr’s syndrome is crucial, in which there are specific causes for the calcification of the basal ganglia, such as hypoparathyroidism. Senile calcification of the basal ganglia without clinical symptoms with no underlying cause is an incidental finding that is seen in some people over 60 years old. These are also important differentials Perugula and Lippmann 2016(). When psychiatric symptoms and abnormal movements coincide with idiopathic calcification of the brain in a patient, Fahr syndrome is suggested, especially if it is accompanied by neurological symptoms, cognitive deficits, and some degree of mental retardation (Rücker, Halder et al. 2019).
The gradual onset of symptoms in this patient characterized by behavioral changes and a lower-than-normal IQ, has been reported in several studies Naqvi, Arshad et al. 2017Palu, Moraes et al. 2021)(, . Psychiatric manifesting in the patient’s third decade of life, followed by movement disorders, is consistent with the early-onset variant of Fahr’s disease (Aghemo, Salmanzadeh et al. 2023).
Despite the co-occurrence of behavioral changes and neurological symptoms, along with neuroimaging findings that suggest Fahr syndrome, it has been reported that there is no clear connection between calcifications and neurological symptoms Pistacchi, Gioulis et al. 2016(). The treatment goals involve providing symptomatic support. The response to levodopa in those with Parkinsonian features is reportedly poor. Atypical antipsychotics are the preferred choice for psychiatric symptoms due to the coexistence of the extrapyramidal syndrome in this group of patients (Asokan, D’souza et al. 2013).