Secondary Fahr Syndrome Presenting With In-Flight Generalized Status Epilepticus in a Middle-Aged Male.

Fahr syndrome is a rare neurological condition characterized by bilateral basal ganglia calcifications, typically associated with metabolic disturbances such as calcium-phosphorus imbalance or parathyroid dysfunction. Although often incidental or subclinical, it may present with a range of neuropsychiatric or seizure-related symptoms. Status epilepticus as an initial manifestation is uncommon and rarely reported. We report the case of a 42-year-old male with no prior seizure history who developed generalized status epilepticus during a long-haul international flight. Initial brain imaging revealed extensive bilateral basal ganglia calcifications. Laboratory investigations showed mild ionized hypocalcemia (0.99 mmol/L), secondary hyperparathyroidism, and vitamin D deficiency, with normal renal function. The patient admitted to smoking a significant amount of cannabis (13 joints) before boarding, which may have acted as a seizure trigger in the context of underlying metabolic vulnerability. Secondary Fahr syndrome was diagnosed based on clinical, radiological, and biochemical findings. This case highlights a rare but serious presentation of Fahr syndrome with in-flight generalized status epilepticus.