National Academy of Neuropsychology: Abstracts from the 22nd Annual Meeting, Miami, Florida, October 9–12, 2002

Archives of Clinical Neuropsychology 17 (2002) 715–867 National Academy of Neuropsychology Abstracts from the 22nd Annual Meeting, Miami, Florida, October 9–12, 2002 (Convention Abstracts Accepted under the Guest Editorship of Philip Schatz, Ph.D. and Stephen Moelter, Ph.D.) GRAND ROUNDS Differential diagnosis of neurodegenerative disorders in a 43-year-old female Bullard SE, Lovejoy DW, Oakes HJ The current study presents the behavioral abnormalities, neuroimaging and neuropsychological results of a 43-year-old woman with a previous history of osteogenesis imperfecta and scoliosis. She presented with a 4-year history of cognitive impairments, characterized by memory, attentional and word-finding difficulties and then followed by numbness, fatigue, urinary incontinence, balance difficulties, disinhibition and emotional flattening. Cranial CT study revealed advanced cerebral atrophy for a patient of this age. EEG study noted disturbance in the left temporal region. MRI finding evidenced prominent sulci over the frontal and parietal lobes and some thinning of the corpus collosum. PET study results indicated mild to moderate diminished metabolic activity within the temporoparietal cortex and decreased neuronal functional activity involving the medial segment of both hemispheres. The patient has been followed up 1 year later with neuropsychological testing and comparison of her neuropsychological profiles across examinations is presented. The results are discussed with reference to the features (clinical and neuropsychological) which distinguish neurodegenerative disorders and the relationship of theses findings to Pick’s disease, corticobasal ganglionic degeneration (CBGD) and multiple system atrophy (MSA). The case illustrates the need for detailed neurological and neuropsychological testing and follow-up and consideration of neurodegenerative disorders in younger patients. Neuropsychological and perfusion MRI correlates of revascularization in an adult case of moyamoya syndrome Jefferson A, Glosser G, Liebeskind D, Detre J, Sinson G Moyamoya syndrome is characterized by occlusion and stenosis in the distribution of the internal carotid, anterior, and middle cerebral arteries with progressive compromise of collateral blood flow. Large artery distribution strokes and ischemia due to collateral failure may precipitate significant disability. Revascularization has recently been promoted for stroke prevention in the setting of moyamoya syndrome, 0887-6177/02/$ – see front matter. PII: S 0 8 8 7 - 6 1 7 7 ( 0 2 ) 0 0 1 6 4 - 6 716 Abstracts / Archives of Clinical Neuropsychology 17 (2002) 715–867 yet the efficacy of such procedures remains unclear. We present a case of a 49-year-old female attorney with moyamoya syndrome who suffered a right middle cerebral artery (MCA) stroke and subsequently underwent revascularization involving direct right superficial temporal artery to MCA bypass. A presurgical neuropsychological evaluation revealed deficits consistent with a lesion in the nondominant right hemisphere (e.g., visuospatial processes) as well as impairments in verbal tasks associated with the left hemisphere (e.g., verbal memory). Presurgical perfusion MRI showed global and bilateral decreases in cerebral blood flow consistent with diffuse neurocognitive dysfunction. Following revascularization, visual perception and nonverbal visuospatial memory improved. Unexpectedly, verbal memory mediated by the left hemisphere also improved to levels consistent with premorbid functioning. These global improvements in cognitive functioning were consistent with postsurgical widespread bilateral increases on perfusion MRI. Thus, findings suggest neuropsychological measures can identify both global and focal cerebrovascular dysfunction associated with moyamoya syndrome. Furthermore, neuropsychological evaluation shows that revascularization for moyamoya syndrome may engender cognitive and neurological improvement beyond focal regions of established ischemia, presumably due to augmentation of global cerebral blood flow. Neuropsychological profile following suicide attempt by hanging: two adolescent case reports Zabel TA, Slomine B, Brady K, Christensen J Hippocampal damage and amnesia following hypoxia are described in the few published adult cases of suicide attempt by hanging. However, a recent review (Caine & Watson, 2000) suggests a more variable pattern of brain involvement and neuropsychological impairments following hypoxic injury that may or may not involve amnesia. We describe two cases of adolescents who survived hanging attempts that differed in degree of memory impairment. Patient #1 (11 years old) is a male with estimated hanging duration of ∼5 min, admission GCS = 7, and coma = 8 days. In Patient #1, initial CT and follow-up MRI were normal. Patient #2 (14 years old) is a male with estimated hanging duration of ∼15 min, admission GCS = 5, and coma = 13 days. In Patient #2, initial MRI showed bilateral parietal and temporal infarction, and follow-up MRI revealed mild atrophy. Both patients had similar IQ (VIQ > PIQ), and deficits were noted in components of expressive and/or receptive language, visual-perceptual ability, attention, and working memory. Both patients also displayed symptoms of executive dysfunction in their acute recovery, including disinhibition and echopraxia (Patient #1), poor initiation, word-cluttering, and confabulation (Patient #2), and perseveration (both cases). Despite these similarities, only Patient #2 presented with classic amnesia, and this presentation continued into his postacute recovery. While Patient #1 initially displayed memory deficits, they were less severe and improved as initial confusion resolved. Injury-related variables thought to contribute to these variable patterns of neuropsychological deficits following attempted hanging in adolescents will be discussed, including hanging duration, time until restoration of respiration, and extent of neuroanatomic injury. PEDIATRIC GRAND ROUNDS The effects of hemorrhagic stroke on an 8-year-old child: a case study Escalona A, Greene L, Mohrland M, Golden Z, Golden CJ Incidents of strokes are more characteristic of elderly populations than of infancy or childhood (Spreen, Risser, & Edgell, 1995). In this case study, the client was an 8-year-old Caucasian female who had had a stroke at the age of six. Prior to the stroke she had complained of severe headaches accompanied by vomiting. Her father soon noticed that she was not using the right side of her body and that she Abstracts / Archives of Clinical Neuropsychology 17 (2002) 715–867 717 was noncommunicative. A CAT scan performed days later revealed that she had had a stroke. A MRI confirmed a left frontal temporal parietal infarction consistent with a large middle cerebral artery distribution stroke. An initial neuropsychological examination performed 2 months after the stroke revealed that the client suffered from aphasia with exp (...truncated)