Fahr's disease and psychiatric syndromes: A case series
Mrs. A, a 70-year-old female who was premorbidly well adjusted and had no past history of mental disorders presented with an insidious onset illness of 6 months’ duration, characterized by muttering to self, irritability, delusions of reference and persecution, and auditory hallucinations of discussing type. Over a period of 3 months, her psychotic symptoms worsened, and, after this, in addition to the psychiatric symptoms she developed bilateral tremors of hand. On physical examination at first evaluation, she was found to have chewing movements of mouth and bilateral tremors of hand (both resting and intentional). There was no evidence of rigidity and cerebellar signs. Her investigations in the form of hemogram, blood biochemistry including serum calcium levels, liver function tests, renal function tests, thyroid function tests, parathyroid hormone levels, electroencephalogram, and electrocardiogram did not reveal any abnormality. However, her fasting and post-prandial glucose levels suggested that she was suffering from diabetes mellitus. In view of the late age of onset of psychosis, a non-contrast computerized tomography (NCCT) of brain was done, which showed calcification of bilateral globus pallidus. In view of the same, in liaison with a neurologist, a magnetic resonance imaging of brain was done, which showed nonspecific T2 flair hyperintensities in bilateral centrum semiovale and periventricular white matter. In view of the BGC, history was further explored, which did not reveal any family history of psychosis or BGC. In view of the late-onset psychosis, presence of movement disorder, BGC on NCCT, lack of evidence of parathyroid abnormality, and lack of family history of BGC or psychosis, a diagnosis of Fahr's disease (FD) was considered. She was managed with T. Olanzapine 7.5 mg/day with which she showed improvement over a period of 12 weeks. Her diabetes mellitus was managed with Glimeside 1 mg/day.