PPT clinical case 20221222

Clinical
Case
Multiple sclerosis


TABLE OF
CONTENTS

01

ABOUT THE PATIENT
DIAGNOSIS
Demographics,
medical & psych
history

DISCUSSION

Summary and
impression

02

Neuropsych
assessment resul
ts and
observations

03

TREATMENT

04

Description of
recommendation
s and
treatments

2


TEAM

Lauren Dalokay
Extern, neuropsych
evaluation 

Dr. Tehila EilamStock
Supervisor of
neuropsychology
case

Maureen Sessa
Extern, Cognitive
Behavior
Therapy

3

INTRODUCTION

Referral reason
A 33-year-old, righthanded, Asian American
woman referred by
neurologist for an
evaluation due to
reported cognitive
difficulties, in the context
of relapsing-remitting
multiple sclerosis (MS)
diagnosed in 2019. 
4


IDENTIFYING
INFORMATION

Background: 33
y/o
female, Raised in
NY, speaks,
Gujarati and
English, Lives
alone, no children.
Good social
support 

Education:
Bachelor’s degree

in nursing (BSN);
took Adderall when
studying for her
college and board
exams, with benefit

Occupation: OR
nurse at a private
practice for plastic
surgery

5


PATIENT
MEDICAL &
PSYCH HISTORY

Onset of numbness
and tingling in her
right hand, Dx with
CIS

2018
Depression &
anxiety following
her brothers
death; passive SI

Current Medications::

include venlafaxine (75
mg), and vitamin D3.
Other Hx: High cholesterol
Neuroimaging
study showed
disease
progression,
diagnosed with
MS

2019
She was arrested
for DWAI.
Trials of Zoloft
and
psychotherapy

Discontinued DMT:
difficulty accepting
her diagnosis and
concerns of
medication sideeffects;

20202021

Numbness, tingling, and
weakness in her right
hand, intermittent pain
and tingling in her right
leg (from foot to knee),

and fatigue.

2022

Discontinued meds
and therapy due to
the COVID-19
pandemic’s social
restrictions

Recently
started
cognitive
behavioral
therapy (CBT)
at Burke and

6


COGNITIVE &
MOOD
COMPLAINTS
Fluctuating changes over past 1-2
years:
◂ Attention and concentration
(e.g., not being able to follow
content of books, losing track of
television show plots, misplacing
objects)

◂ Memory (e.g., difficulty recalling
details of conversations,
repeating questions
◂ Slow processing speed and
executive dysfunction (decision
making).
◂ Occasionally forgets to take
medications

◂ Significant levels of depression with
features of anxiety
◂ Marked by sadness, anhedonia,
frequent crying
◂ Poor appetite (with no significant
weight loss),
◂ Disturbed sleep
◂ Irritability
◂ Smokes marijuana nightly for
anxiety management
◂ Drinks 2-3 glasses of wine once a
week (increased use in past)
7


IMAGING
RESULTS

Neuroimaging:
Brain MRI on 8/8/22
showed multiple white

mater lesions in the
periventricular and
collasoseptal areas,
Spine MRI on 8/8/22 and
8/23/22 showed stable
demyelinating lesions at
levels C2, C3, C6, C7, T3,
T11, and T12,
8


FINDINGS: GENERAL
INTELLECTUAL
FUNCTIONING

9


Attention and
Processing Speed

1
0


Executive Functioning

1
1

LEARNING
AND
MEMORY

1
2


VISUOSPATIAL/VISUOM
OTOR

1
3


DISCUSSION
SUMMARY
Mild to moderate impairment in processing speed, executive
functions, and visual learning, suggesting frontal-subcortical
dysfunction. In addition, variability in performance across tasks
suggest difficulty maintaining cognitive stamina and focus. 
Significant levels of emotional distress, alcohol and
cannabis use, poor sleep, and fatigue, are likely further
exacerbating her daily cognitive functioning. 
Finally, reported history of developmentally-based
attention and learning difficulties, as well as slowed
processing speed since childhood; these premorbid
vulnerabilities may have been worsened by MS

TREATMENT &
Recommendations
1. MS treatment and management, adherence to
medications 
2. Workplace accommodations for individuals with
MS
3. Psychotherapy, she has started a course of CBT
at Burke. Dialectical behavior therapy (DBT) is also
recommended
4. Limiting alcohol and cannabis use
5. occupational therapy referral is recommended
for fine motor rehabilitation
6. Driving evaluation through the occupational
therapy department 
7. Lifestyle and behavioral recommendations
8. Follow-up neuropsychological evaluation is
recommended in 12-18 months

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5


THANKS
Does anyone have any
questions?


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