[Idiopathic bilateral basal ganglia calcification (Fahr's disease) presenting with psychotic depression and criminal violence: a case report with forensic aspect]

Abstract

Fahr's disease is a rare neuropsychiatric disease characterized by bilateral intracranial calcification, primarily in the basal ganglia. The more general term, Fahr's syndrome, is used for primary and secondary basal ganglia calcification, regardless of the etiology, but the term Fahr's disease is used to describe primary, idiopathic cases. Fahr's disease may present with neurological symptoms, such as parkinsonism and extrapyramidal symptoms, dysarthria, paresis, convulsion, and syncope. Psychiatric disorders, including behavioral disorders, psychosis, and mood disorders, as well as cognitive disorders can occur. CT is useful for the diagnosis of Fahr's disease. Herein we present a patient diagnosed as Fahr's disease that presented with symptoms of depression, delusions, and auditory hallucinations. The 47-year-old male patient was hospitalized in a forensic psychiatry inpatient clinic due to aggressive behavior and was subsequently diagnosed with major depressive disorder with psychotic features. While hospitalized he was treated with antidepressant and antipsychotic drugs, as well as electroconvulsive therapy, resulting in significant improvement in his symptoms. As bilateral basal ganglia calcification was observed via CT, the patient was diagnosed as Fahr's disease. This case report emphasizes the importance of cranial imaging and detailed laboratory examination when evaluating patients with psychosis and affective symptoms. Pathologies such as Fahr's disease must be included in the differential diagnosis, especially in cases with neurological symptoms and cranial imaging findings.