Acute neurological decline in Fahr's syndrome: a rare case suggesting viral illness as a potential trigger.

Introduction and importance: Fahr's syndrome is a rare neurodegenerative disorder characterized by bilateral intracranial calcifications, primarily affecting the basal ganglia, thalamus, and cerebellum. It presents with a wide range of neurological and psychiatric symptoms, often mimicking more common conditions. Case presentation: We report the case of a 45-year-old South Asian male with no known comorbidities who presented with acute fever, altered consciousness, and generalized tonic-clonic seizures. Initial management targeted a suspected central nervous system infection, but neuroimaging revealed bilateral basal ganglia calcifications. Clinical discussion: Extensive metabolic and infectious workups were unremarkable, leading to a diagnosis of Fahr's syndrome through multidisciplinary evaluation. Genetic testing was not performed due to financial constraints. The patient showed significant improvement with empirical anticonvulsant therapy and supportive care and was advised outpatient follow-up. Conclusion: This case emphasizes the importance of considering Fahr's syndrome in patients presenting with unexplained neurological symptoms, particularly in resource-limited settings where access to genetic testing is restricted. Early recognition through neuroimaging is crucial to avoid misdiagnosis and ensure appropriate management. Increased awareness among clinicians is necessary for timely intervention and improved patient outcomes.