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

Age of onset can have a significant impact on clinical course and pathophysiological mechanism of bipolar disorder. Late-onsetbipolar 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 frontaland 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 movementdisturbances, the presence of basal ganglia calcification, and worsening of cortical atrophy, we performed a differential diagnosisbetween 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 movementsymptoms. Relationship between medications and course of specific symptoms was observed