Paranoid delusions and cognitive impairment suggesting Fahr's disease.

The authors present the case of a 60-year-old woman with elaborate paranoid delusions and cognitive impairment found during a workup for atypical chest pain. Clinical evaluation revealed mild dementia, and radiography showed basal ganglia calcification consistent with Fahr's disease. She was treated with risperidone and transferred to a psychiatric inpatient unit for definitive care. Psychiatrists should consider Fahr's disease as a differential diagnosis in the evaluation of psychosis and cognitive impairment when neuroimaging reveals calcification of the basal ganglia.