Abstract
Abstract Multimodal assessment practices offer enriching contributions to linkages between clinical presentation and brain presen-tation. The following case study is an illustration of the effectiveness of structural and functional imaging in the diagnosis process. In this article a clinical vignette is given in which the client (Mr. B) presents with aggressive behavior, delu-sions, memory complaints and hoarding behaviors. The findings of the case of presented based on multimodal structural and functional imaging. Mr. B was evaluated using MRI (magnetic resonance imaging), EEG (electroencephalography), qEEG (quantitative EEG), LORETA (low resolution electromagnetic tomography), SPECT (single photon emission computed tomography), quantitative SPECT and neuropsychological testing. Visual analysis of EEG recording revealed sharp waves with reversals primarily in the mid-central region (Cz). Quantita-tive analysis of background activity acquired in eyes closed and alert state revealed increased absolute and relative beta power maximally distributed to the mid-central region (Cz). This was consistent with the source analysis obtained from LORETA. Visual inspection of SPECT data indicated increased blood perfusion in the posterior cingulate cortex. The quantitative analysis of SPECT images, on the contrary revealed decreased perfusion in both anterior and posterior cingu-late cortex. Furthermore, increased perfusion in bilateral sensori-motor cortices (right more than left) and decreased per-fusion in the left posterior temporal lobe was observed. T-1 based MRI of the brain showed generalized cerebral atrophy. On neuropsychological testing Mr. B was able to complete only tests of lesser complexity. Base on published data Mr. B’s structural and functional imaging can be linked to his clinical presentation and a potential diagnosis of Frontal Tem-poral lobe Disorder (FTD). The use of multimodalities and objective analysis of data can lead to more accurate case con-ceptualizations and linkages between brain structure/functionality and clinical presentation.
Highlights
This is the case of Mr B who was evaluated and provided psychiatric care during his inpatient stay at Hines VA Hospital in February 2004
From this conclusion one could argue the importance of linkage between imaging and clinical presentation and use Mr B’s neuroimaging information to represent Frontal Temporal lobe Disorder (FTD) findings within the brain
Decreased perfusion of left posterior temporal lobe as seen on quantitative analysis of SPECT might be reflective of hippocampal dysfunction, manifesting itself as memory impairment
Summary
This is the case of Mr B who was evaluated and provided psychiatric care during his inpatient stay at Hines VA Hospital in February 2004. Mr B, an 83-year-old Caucasian male was brought to the emergency room from an assisted living facility because of uncontrollable aggressive behavior towards his wife and others He had delusions (jealous type) that his wife was being unfaithful to him, and had made verbally aggressive threats to her in the past. Mr B attempted to pursue accumulating newspaper clippings even on the psychiatric inpatient unit He demonstrated little insight into this behavior. Mr B was talkative, impulsive and grandiose at the time of presentation He was given a working diagnosis by the primary team, of Bipolar I Disorder, most recent episode manic, with psychotic features (DSM-IV: 296.44) and probable AD (Dementia of the Alzheimer’s type), with behavioral disturbance (294.11) (American Psychiatric Association, 2000). We hypothesized that a complex case such as this could be better conceptualized by objective analysis of data from multiple neuroimaging modalities
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