Identifying Information
The patient is a single, 66-year old, right-handed male referred for
neuropsychological testing by Dr. JH. The patient has had depression
for many years and his current psychiatrist is Dr. TM. While he has
also had "a very poor memory for a number of years: he believes this
may be worsening. Given these difficulties neuropsychological
assessment was requested.
Relevant Background
The patient
first noticed memory problems in 1971 but believes they have since
worsened. On a neuropsychological questionnaire the patient endorsed
bilateral headaches which originate in the rear of his head. Sudden
movement makes them worse. These headaches are currently largely
resolved. He also endorsed sometimes no understanding things he has
read. The patient also endorsed hand tremors which he claimed were
related to treatment with Lexapro; while not constant they have
improved over time. He also endorsed starting to say something and then
forgetting what it was. He often feels worried or anxious. Results of a
CT scan (9/8/08) showed ""slight asymmetry of mildly prominent extra
axial spaces at the convexities, right greater than left without
associated mass effect...this may simply represent slightly asymmetric
cerebral volume loss. If the patient has a history of recent trauma
and/or coagulopathy, this could represent a small chronic/resolving
subdural hematoma or subdural hygroma."
The patient reported a significant psychiatric history of
depression of long duration. He was in psychoanalysis in the early
1960's for 3 years. He has been treated with antidepressants since
1975. He suffered severe depression in 2004 and he reported receiving
24 bilateral ECT sessions from Dr. IF. He believes that his cognitive
difficulties may have worsened as a result. He also received
psychotherapy for 15 years by Dr. IS which he regards highly. "he saved
my life". Otherwise, the patient denied any significant thistly of
alcohol or substance use.
The patient also reported a significant neurological history. He was
hit by a car at the age 6 and had at least a concussion (he could not
remember whether he was in a coma). He could not recall if there were
significant differences following this trauma though indicated that
"concentration has been a problem historically". He does not believe
that he has ever been evaluated by a neurologist. His familial history
is significant for a paternal grandfather who had a stroke and his
father died of bladder cancer which metastasized to the brain.
Otherwise, he regards himself to be in :great health", though did
endorse fatiguing easily. The patient is currently taking Bupropion,
Cymbalta, Lamictal, Geodon, Ritalin, Gabapentin, Lipitor and Asprin.
The patient brought a typed list of unusual symptoms that he had
experienced over the last 35+ years. He describes fatigue from bathing
and is currently only managing to take "a full shower once a week and
bird bathing the rest of the week?. He first noticed this fatigue in
1971. He also describes "muscle motor sensation" involving the
"vibration of the whole muscle".