# Delirious Hyperactivity and Agitation in a Young Male Unveiling an Intriguing Underlying Diagnosis: Case Report

## TL;DR

A young man with a psychiatric history presented with delirious hyperactivity, but was found to have Fahr disease, a rare neurodegenerative condition.

## Contribution

This case report highlights the importance of considering rare neurodegenerative conditions in patients with altered mental status and psychiatric histories.

## Key findings

- A 23-year-old male with bipolar disorder and developmental delay was diagnosed with Fahr disease after presenting with delirious hyperactivity.
- Fahr disease was identified via CT scan showing calcium deposits in the basal ganglia.
- The case emphasizes the need for a broad differential diagnosis in emergency settings.

## Abstract

Altered mental status presentations are commonplace in the emergency department (ED), but not all are due to psychiatric etiologies, even if the patient has had a previous psychiatric diagnosis. It is critical to evaluate for organic causes of a patient’s altered presentation. This case highlights the necessity of a broad workup to correctly diagnose an altered patient.

A 23-year-old Haitian male with a past medical history of bipolar 1 disorder, seizure disorder, and developmental delay presented to a critical access ED for altered mental status. The patient was given 300 milligrams of ketamine for delirious hyperactivity and agitation by emergency medical services in the field. On physical examination, the patient was in acute respiratory distress, hypoxic, not tolerating secretions, tachycardic, lethargic, and was subsequently intubated for airway protection. Computed tomography (CT) of the brain without contrast was obtained and revealed findings consistent with Fahr disease.

Fahr disease is a rare neurodegenerative condition that causes accumulation of calcium deposits in the basal ganglia as demonstrated on CT.1 Phenotypes can be variable, including symptoms such as parkinsonism, chorea, dystonia, cognitive impairment, and ataxia.2 This case illustrates the importance of a broad differential diagnosis and emergent medical interventions for emergency physicians practicing in critical access facilities.