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Introduction and aim. Fahr's disease is a rare neurological disorder characterized by bilateral basal ganglia calcifications. The aim of this report is to highlight a case of Fahr's disease with atypical features such as neck rigidity and peripheral nerve involvement. Description of the case. Here, we present the case of a South Asian patient with secondary Fahr's disease whose clinical presentation mimicked that of meningoencephalitis. The patient had neurological and neuropsychiatric symptoms along with abnormal body movements. She also had restricted neck mobility. Computed tomography of the head revealed bilateral dense calcifications in the basal ganglia suggestive of Fahr's syndrome. Investigations revealed severe hypocalcemia, hyperphosphatemia, and low parathyroid hormone levels, which led to the identification of hypoparathyroidism as the underlying cause. The presence of pre-existing epilepsy and neck rigidity made the diagnosis difficult. The relatively rapid development of symptoms along with the presence of peripheral nerve involvement made this case even more unique. Calcium levels were corrected, and there was a marked symptomatic improvement. Conclusion. Neck rigidity and restricted neck mobility may be present in cases of Fahr's syndrome due to calcifications of the nuchal ligament or other spinal ligaments and thus must be differentiated from meningoencephalitis. Although the symptoms of Fahr's syndrome are generally limited to the central nervous system, there may be involvement of the peripheral nerves as well. [ABSTRACT FROM AUTHOR]

Objectives: This study was conducted with the aim of assessing the correlation between highly sensitive C reactive protein (hsCRP) levels and indicators of disability and functional impairment in individuals presenting with acute ischaemic stroke (AIS)., Design: Cross-sectional study., Setting: Department of General Medicine at the All India Institute of Medical Sciences, Patna, Eastern India from August 2022 to August 2023., Participants: The study population comprised a total of 125 patients aged 18 years or more, presenting within 48 hours of symptom onset or time last known well and having confirmed ischaemic stroke through CT or MRI of the brain. Individuals with a history of prior stroke, other neurological disorders, active infections, known coronary artery disease, chronic kidney disease, chronic liver disease and abnormal blood cell counts were excluded., Primary Outcome Measures: Modified Rankin scale (mRS) and Barthel Index (BI) scores on day 2 and day 5 were the primary outcome measures., Results: The hsCRP levels on day 2 and day 5 were significantly positively correlated with the National Institutes of Health Stroke Scale scores with Spearman's rho 0.303 (p=0.001) and 0.386 (p<0.001), respectively. The hsCRP on day 2 exhibited a significant association with mRS scores (p=0.04), indicating disability, but this significance was not sustained on day 5 (p=0.125). A negative correlation was observed between hsCRP and BI scores on both day 2 (Spearman's rho=-0.265, p=0.003) and day 5 (Spearman's rho=-0.297, p=0.002). While the hsCRP levels on day 2 did not differ significantly between fatal and non-fatal cases (p=0.110), the hsCRP levels on day 5 were significantly higher in fatal cases (p<0.001)., Conclusions: This study underscores the potential utility of hsCRP as a prognostic indicator in patients with AIS. Elevated hsCRP levels correlated with increased stroke severity and functional disability. Regular assessments of hsCRP in the early phase of AIS could contribute to predicting prognosis and guiding optimal patient management., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)