LAUSR

In right hemisphere cerebrovascular accident (CVA), expected deficits might include inattention syndromes, visuospatial impairment, or neglect. This case study adds to the literature by presenting neuropsychological data from a patient with a complex medical history who experienced two right hemisphere CVAs. The aim is to demonstrate that neuropsychological deficits following CVA may not be as expected in patients with comorbidities, and to highlight the importance of neuropsychological assessment in such cases. The patient is a 69-year-old, right-handed, African American man who presented with reading and memory difficulties, problems recognizing faces, and vision impairment following right occipital and temporoparietal ischemic CVAs. Comprehensive neuropsychological evaluation was conducted. Formal measures were utilized, but the examiners were also required to devise appropriate bedside measures. The patient had difficulty recognizing his caregiver’s face. He could not identify facial expressions made by examiners, but commented on individual facial features. Design copies were distorted/fragmented, and he evidenced difficulty integrating visual components into a whole. He also demonstrated spelling and verbal memory impairment (BDAE Oral Spelling raw = 0; HVLT-R recall and recognition < 1st percentile). Full results are included in a supplemental data table. Results were strongly suggestive of simultanagnosia, though this disorder typically results from bilateral parietal-occipital lesions. Additionally, the neuropsychological impairments noted extended beyond those typical of right hemisphere CVA, likely related to the patient’s history of multiple comorbidities (e.g., infectious disease, polysubstance abuse). This case highlights the importance of neuropsychological assessment in the care of medically complex patients, and the unique ability of neuropsychologists to conduct such evaluations.