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{
    "pk": 33483,
    "title": "Delirious Hyperactivity and Agitation in a Young Male Unveiling an Intriguing Underlying Diagnosis: Case Report",
    "subtitle": null,
    "abstract": "<p><strong>Introduction</strong>: Altered mental status presentations are commonplace in the emergency department (ED), but not all are due to psychiatric etiologies, even if the patient has had a previous psychiatric diagnosis. It is critical to evaluate for organic causes of a patient’s altered presentation. This case highlights the necessity of a broad workup to correctly diagnose an altered patient.</p>\n<p><strong>Case Report: </strong>A 23-year-old Haitian male with a past medical history of bipolar 1 disorder, seizure disorder, and developmental delay presented to a critical access ED for altered mental status. The patient was given 300 milligrams of ketamine for delirious hyperactivity and agitation by emergency medical services in the field. On physical examination, the patient was in acute respiratory distress, hypoxic, not tolerating secretions, tachycardic, lethargic, and was subsequently intubated for airway protection. Computed tomography (CT) of the brain without contrast was obtained and revealed findings consistent with Fahr disease.</p>\n<p><strong>Conclusion</strong>: Fahr disease is a rare neurodegenerative condition that causes accumulation of calcium deposits in the basal ganglia as demonstrated on CT. Phenotypes can be variable, including<br>symptoms such as parkinsonism, chorea, dystonia, cognitive impairment, and ataxia. This case illustrates the importance of a broad differential diagnosis and emergent medical interventions for emergency physicians practicing in critical access facilities.</p>",
    "language": "eng",
    "license": {
        "name": "Creative Commons Attribution 4.0",
        "short_name": "CC BY 4.0",
        "text": "Attribution — You must give appropriate credit, provide a link to the license, and indicate if changes were made. You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use.\r\n\r\nNo additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits.",
        "url": "https://creativecommons.org/licenses/by/4.0"
    },
    "keywords": [
        {
            "word": "Delirious hyperactivity"
        },
        {
            "word": "agitation"
        },
        {
            "word": "basal ganglia"
        },
        {
            "word": "Fahr disease"
        },
        {
            "word": "intracranial calcifications"
        }
    ],
    "section": "Case Reports",
    "is_remote": true,
    "remote_url": "https://escholarship.org/uc/item/0tm5g8x9",
    "frozenauthors": [
        {
            "first_name": "Mitch",
            "middle_name": "",
            "last_name": "Garey",
            "name_suffix": "",
            "institution": "HCA FL Aventura Hospital, Department of Emergency Medicine, Florida",
            "department": ""
        },
        {
            "first_name": "Joy",
            "middle_name": "",
            "last_name": "McLaughlin",
            "name_suffix": "",
            "institution": "HCA FL Aventura Hospital, Department of Emergency Medicine, Florida",
            "department": ""
        },
        {
            "first_name": "Harman",
            "middle_name": "",
            "last_name": "Kaur",
            "name_suffix": "",
            "institution": "HCA FL Aventura Hospital, Department of Emergency Medicine, Florida",
            "department": ""
        },
        {
            "first_name": "Jason",
            "middle_name": "",
            "last_name": "Graf",
            "name_suffix": "",
            "institution": "HCA FL Aventura Hospital, Department of Emergency Medicine, Florida",
            "department": ""
        },
        {
            "first_name": "Jacklyn",
            "middle_name": "",
            "last_name": "Garcia",
            "name_suffix": "",
            "institution": "HCA FL Aventura Hospital, Department of Radiology, Florida",
            "department": ""
        },
        {
            "first_name": "Megan",
            "middle_name": "Elizabeth",
            "last_name": "Dekok",
            "name_suffix": "MSc",
            "institution": "Rocky Vista University College of Osteopathic Medicine, Parker, Colorado",
            "department": ""
        },
        {
            "first_name": "Alexander",
            "middle_name": "John",
            "last_name": "Scumpia",
            "name_suffix": "",
            "institution": "HCA FL Aventura Hospital, Department of Emergency Medicine, Florida; Lakeside Medical Center, Department of Emergency Medicine, Belle Glade, Florida",
            "department": ""
        }
    ],
    "date_submitted": "2024-09-16T17:31:45.393000+02:00",
    "date_accepted": "2025-01-18T00:47:42.044000+01:00",
    "date_published": "2025-05-10T22:04:00+02:00",
    "render_galley": null,
    "galleys": [
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            "label": "PDF",
            "type": "pdf",
            "path": "https://journalpub.escholarship.org/uciem_cpcem/article/33483/galley/38476/download/"
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    ]
}