C-69 Neuropsychological Functioning in a Patient with an Unspecified Pediatric Movement Disorder Without Abnormal Brain MRI

Abstract

Abstract Objective Neuropsychological profiles of patients with pediatric movement disorders are not fully understood, though research suggests greater impairments in cognitive processes reliant on white matter functional integrity. Interpretation of neuropsychological data in these patients is often informed by imaging data that suggests specific areas of brain abnormality. The purpose of this presentation is to discuss the neurocognitive profile of a patient with an unspecified, progressive movement disorder with onset in middle childhood with no observable brain abnormality. Method The patient is an 11-year-old, right-handed male with a history of spastic diplegia and ataxia, onset at seven years of age, in the context of a normal brain MRI and genetic anomaly of unclear clinical significance. Patient has since experienced progressive weakness and spasticity of his bilateral lower limbs, and increasing inflammation in the upper thoracic region. He also has a history of auditory hallucinations. Results His neuropsychological profile was indicative of white matter and right hemispheric dysfunction in the brain with well-preserved left hemisphere functions. He demonstrated stronger verbal reasoning and verbally-based executive functioning abilities compared to visual-spatial reasoning and visual perception. Deficits in sustained attention, vigilance, working memory, and processing speed were also noted. Psychomotor coordination and planning was impaired bilaterally, with more pronounced left-hand deficits. He also demonstrated significant speech dysarthria and dyspraxia. He denied experiencing auditory hallucinations in the past six months. Conclusions This patient’s neurocognitive profile is largely consistent with literature on neuropsychological functioning in pediatric movement disorders despite the absence of an identifiable region of brain abnormality.