Fahr Syndrome Identified During Evaluation of Recurrent Seizure-Like Activity in a Middle-Aged Woman.

Fahr syndrome is a rare neurologic disorder characterized by bilateral intracranial calcifications, most commonly involving the basal ganglia, and is typically diagnosed after exclusion of secondary metabolic, infectious, and endocrine causes. Clinical manifestations are variable and may include seizures, cognitive impairment, behavioral changes, movement abnormalities, and altered mental status. We present the case of a 55-year-old woman with recurrent episodes of altered mental status and seizure-like activity whose neuroimaging consistently demonstrated extensive, symmetric cerebral and cerebellar calcifications. Despite multiple hospitalizations and a comprehensive diagnostic evaluation, including metabolic, infectious, and structural workup, no alternative etiology was identified. The patient was ultimately diagnosed with Fahr syndrome. This case highlights the importance of recognizing Fahr syndrome in patients with characteristic imaging findings during the evaluation of common neurologic presentations and emphasizes the role of a systematic, exclusion-based approach to diagnosis.