Disclosures: Shelly Gulhar, MD: No financial relationships or conflicts of interest

Case Diagnosis: A 61-year-old male with a history of developmental delay presenting with Fahr’s disease.

Case Description: A 61-year-old male who presented with worsening functional status after experiencing multiple falls with ambulation. Examination demonstrated balance impairment, bradykinesia, postural instability, and rigidity. Head CT revealed extensive bilateral symmetric dystrophic calcifications. Ionized calcium was normal. He was diagnosed with pseudohypoparathyroidism and started on calcitriol and calcium carbonate. Given parkinsonian symptoms, he was also started on Sinemet, which improved his bradykinesia and rigidity.

Setting: Acute Inpatient Rehabilitation FacilityAssessment/

Results: At the time of admission to the inpatient rehabilitation facility, he initially required moderate assistance to safely perform transfers from the bed to the chair and had a forward flexed, shuffling gait. By discharge, he progressed to performing all bed mobility independently and transfers with supervision. He ambulated more than 300 feet with a rolling walker and minimal assistance and negotiated 12 stairs with bilateral handrails and close supervision. He improved from 41 to 45 on the Berg balance scale. The patient was able to return home with 24-hour supervision.

Discussion: Fahr’s disease is a rare neurodegenerative disorder that predominantly causes movement disorders resembling Parkinson’s disease and neuropsychiatric symptoms. It is caused by symmetrical, bilateral calcifications of the basal ganglia and other areas of the brain. Diagnosis is made by clinical symptoms and calcifications seen on neuroimaging. While no specific treatment exists and studies that evaluated long-term follow up of Fahr’s disease are limited, appropriate medication treatment for symptom management in conjunction with rehabilitation can provide excellent outcomes in patients.

Conclusion: Individualized care consisting of appropriate medication management and tailored rehabilitation are needed to care for patients with Fahr’s disease. Additionally, discussing goals of care and understanding family dynamics in these patients serve to improve overall functional outcomes and improve patient quality of life

Level of Evidence: Level IV

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/parkinsonism-due-to-basal-ganglia-calcifications-due-to-pseudohypoparathyroidism-and-fahrs-disease-a-case-report/