Case Study
Case_Study_PSYC3250 PSYC 3250 Term Paper Assignment CASE STUDY One of the great challenges that behavioural neurologists and neuropsychologists face is integrating a seemingly random collection of signs and symptoms into a coherent and conceptually sound diagnosis of a disorder. The following case is a detailed description of neurological signs and symptoms presented by a patient in a neuropsychology clinic. Your task is to: • Name and describe the signs, symptoms and potential syndrome(s) (see term paper tutorial for review). • Determine cognitive domain(s) impacted and possible brain damage localization (be specific!). Also describe other areas of cognitive functioning that you think might be impacted based on cognitive neuroscience research. Describe other clinically relevant data you would like to obtain (e.g. neuroimaging, neuropsychological reports etc.). • Provide potential diagnoses - list 2-3 possible diagnoses that you feel should be considered based on the facts of the case. Then narrow your reasoning down to what you feel is the most likely diagnosis. Each of these aspects should be fully explained and justified based primarily on information provided in the course (including the lectures). In addition to the course materials, you should cite two (2) additional research papers related to your final diagnosis and that have informed your clinical decision-making process. HOWEVER, this is not intended as a research paper. I do not expect lengthy discussions on the etiologies (i.e., causes) nor an extensive bibliography. You may write 750 words for this assignment so your thoughts should be well reasoned and precisely stated. Superfluous writing and unfounded statements are STRONGLY discouraged. It is important to remember that this term paper is NOT about training you as a neurologist. We are not concerned whether you identify a correct diagnosis. What we are looking for is a well-reasoned, logical approach to how you arrived at your answers to each of these questions, drawing from what we have learned in class. This neurological case analysis is an opportunity to demonstrate that you are attaining an understanding of brain and behavior relationships. In this case study, we are using the tool of human neuropsychology to map deficits observed in the clinic to a specific site of brain damage (i.e., brain-behavior mapping). Then we are asking you to think more broadly about what might have happened to the brain, leading to the emergence of those deficits. BRIEF CLINICAL HISTORY Patient M.B. M.B., a 55-year-old right-handed woman, was referred to the clinic by a social worker at the assisted care centre where Ms. M.B. is currently living. The social worker and other members of the medical team expressed concerns about possible onset of psychotic episodes. She reported that M.B. had become somewhat non- communicative, but when engaged, she related increasingly improbable anecdotes about her earlier life as a concert pianist. While the content of these stories was somewhat impoverished, the details she was able to convey included stories of concert tours with several well-known orchestras. Ms. M.B. was accompanied to the appointment by a personal care worker. She was appropriately groomed although she appeared somewhat disheveled. Her care worker indicated that she has to be reminded daily to maintain her personal hygiene. She was cooperative and pleasant when directly engaged, however, she was quiet and did not spontaneously engage in conversations. She appeared generally unconcerned about the reasons for the clinical referral. M.B. has been living in the assisted living facility for about 6 months and has been estranged from her family for the last several years. According to the care worker, Ms. M.B. does have two close female friends who visit regularly. While the details are unclear, it appears that her position as a concert pianist ended about a decade ago for reasons related to her unreliability, and inconsistency in her performances. Her employment records since that time have been spotty. Recent medical history was positive for pneumonia and there was a brief note in the medical record suggesting that malnutrition was suspected at one point, prompting action to have her admitted to the assisted living facility. Hospital records revealed that she was admitted to the emergency department approximately 1 month ago, following a visit with one of her friends. She was found lying on the floor of her room incoherent and disoriented. Examination in the E.R. revealed abnormal eye movements. She was released from the emergency within 24 hours and returned to the assisted living facility. Medical history since that time was unremarkable. Upon examination, overall intellectual functioning was revealed to be in the high average range. Vocabulary and spatial reasoning were both high average. Other tests of verbal ability, for example naming objects appeared to be normal. On a brief measure to assess overall cognitive status (mini-mental status exam) M.B. was unable to recall any of three words presented five minutes earlier, although she gave a long list of incorrect words, stating with considerable conviction that she recalled hearing them. Subsequent testing revealed that M.B. had significant difficulty recalling a more extensive (16 word) list after a 20-minute delay. Indeed, when questioned she did not recall being presented with a word list. Again, she had numerous intrusions (stating words that were not on the original list). However, she performed above chance on a forced choice word list. On a word stem completion test, M.B. selected a disproportionate number of previously studies target words even though she did not recall studying the word list. When testing her spatial memory, her ability to reproduce a 2-dimensional spatially figure from memory after a 30-minute delay was severely impoverished. As with the word list, she did not recall studying the figure. On a test, of executive function and processing speed (Trails A & B), M.B. had difficulty switching categories from letter to numbers, however, her performance was most notable for her severely slow response times. On another measure of processing and motor speed, the Finger Tapping Test, her performance was in the impaired range for both hands. Neuroimaging revealed global cortical atrophy with a notation of abnormal, although unspecified, appearance of the diencephalic structures. Despite a general absence of spontaneous speech, it is notable that at the end of the testing session M.B. became animated while relating a story from her former career as a pianist where she performed with Leonard Bernstein at Carnegie Hall. On follow-up she indicated that she had played in many of the world’s greatest concert halls and is frequently invited back for performances even to this day.