H - 28 Assessment Following Acquired Injury to the Bilingual Brain: La Importancia De Los Determinantes Sociales De La Salud.

Abstract

Given the growth of Latine populations in the U.S., variations in language fluency, educational attainment, quality of academic exposure, and access to medical care are essential social determinants of health to consider when assessing language in first generation immigrants, as illustrated through the following case study. A 17-year-old, Spanish-dominant, right-handed, Latina female with right frontoparietal stroke in the setting of arteriovenous malformation (AVM) was referred for neuropsychological evaluation one year following two consecutive gamma knife procedures. Complications included seizures (well-managed with Vimpat) and cerebral edema (treated with prolonged, high-dose Dexamethasone) followed by iatrogenic Cushing's syndrome. Brain MRI/CT were consistent with ruptured right frontoparietal AVM and vasogenic edema. Patient was a sequential language learner; education was received in Spanish until immigration from Colombia to the U.S. two years prior to injury. Parents completed higher education in Colombia. Consistent with stroke location/associated treatments, results indicated a mild neurocognitive disorder with deficits in cognitive efficiency, executive functioning (particularly on visual-based tasks), and memory. Academic skills also aligned with AVM (word reading: high average; reading comprehension: average; calculation: below average). Interestingly, even in the context of high parental education and dual language learner status, personal weaknesses in native language were identified (one-word expression: low average; semantic verbal fluency: below average). Integrating sociocultural demographic factors into the neuropsychological evaluation process supports a culturally-informed assessment approach and is imperative for practice with multilingual speakers. In this case, language concerns may have indicated premorbid weakness or right-sided/bilateral hemispheric language involvement, warranting follow-up fMRI/language mapping prior to further intervention.