Late-Onset Mania in a Patient with Movement Disorder and Basal Ganglia Calcifications: A Challenge for Diagnosis and Treatment

Abstract EN

Age of onset can have a significant impact on clinical course and pathophysiological mechanism of bipolar disorder.

Late-onset bipolar episodes are more likely linked to medical illnesses and so are frequently classified as “secondary” forms of mood disorder.

We discuss the case of a patient who at the age of 58 presented his first delusional-manic episode.

He also had mild frontal and occipital cortical atrophy, white matter posterior ischemic lesions, and small basal ganglia calcifications.

Seven years later, he presented a second manic episode with new emergent hyperkinetic choreiform symptoms.

Taking into account movement disturbances, the presence of basal ganglia calcification, and worsening of cortical atrophy, we performed a differential diagnosis between Fahr disease, Fahr’s syndrome, calcifications due to ageing, supersensitivity psychosis, and dementia.

Valproate, quetiapine, and tetrabenazine were sequentially administered and yielded a good therapeutic response as regards manic and movement symptoms.

Relationship between medications and course of specific symptoms was observed.