Rachel Schlindwein-ZaniniUniversidade Federal de Santa Catarina , Brazil
Title: Neuropsychological assessment of multiple sclerosis case following ingestion of in-prison illegally-made alcoholic drink
Patient, male, 28 years old, right-handed, unfinished undergraduate degree, previously healthy, was admitted to the hospital due to neurological symptoms (ataxia and tremor) and cognitive disorders following the ingestion of in-prison manufactured illegal alcoholic beverage (moonshine), and history of previous use of MDMA/ecstasy and Cannabis. The patient was evaluated by the neurology and neuropsychology service, diagnosed with Multiple Sclerosis (CID G35). Additional diagnoses were Harlequin Syndrome and Horner Syndrome (left hemiface). An MRI exam indicated supra and infratentorial demyelinating lesions and in the cervical spine, some with an indication of inflammatory activity, and degenerative disc disease at C5-C6 and C6-C7. Neuropsychological assessment during the first hospitalization attested extremely low IQ (WASI), and generalized cognitive deficit. Two years later, in a second neuropsychological assessment, the patient remained within the same IQ qualitative classification (QI 43 percentile <0,1 confidence interval 95%, 40-53), but with lower scores (vocabulary: 20 T, Matrix reasoning: 22 T, both important deficit); Verbal memory was assessed and resulted in a deficit (immediate: -2,3 dp; recall: -2,5 dp), NEUROPSIC-R: 37 score (worse at writing) and MMSE score 21 (worse at writing, orientation, drawing, immediate memory, auditory discrimination, and attention), Trail Making Test (inhibitory control) and CDT, both in deficit. Patient showed signs of frontal release with inappropriate behavior, including impaired judgment, impulse modulation (aggressive and sexual). Patient’s health state deteriorated between both longitudinal neuropsychological assessments. The treatment included use of methylprednisolone, levodopa, haloperidol, clonazepam and immunosuppressants, combined with neuropsychological psychoeducation to the patient, family and health team. The present case, with ramifications from primary healthcare to the high-complexity hospital procedures, shows the importance of multi professional healthcare, affecting the scope of medical care and the quality of life of the patient and his family.
Psychologist/ Neuropsychologist of the University Hospital/Universidade Federal de Santa Catarina (UFSC); Professor of the Mental Health master's Program – UFSC; Preceptor in multiprofissional residency – University Hospital/ UFSC; Researcher and Coordinator of “Center of Neuropsychology and Health – HU / UFSC” (Núcleo de Neuropsicologia e Saúde – HU/UFSC). Doctor Degree (PhD) in Medicine (Neuroscience) by PUCRS and Pós-Doc Degree in Psychology by UFSC. She has been reviewer of several reputed journals and she published books in the field, numerous chapters and scientific articles on neuropsychology and mental health throughout her 25-year career.