INS NYC 2024 Program

Poster	Poster Session 09 Program Schedule 02/16/2024 03:30 pm - 04:45 pm Room: Majestic Complex (Posters 61-120) Poster Session 09: Epilepsy \| Oncology \| MS \| Infectious Disease Final Abstract #98 Neuropsychological Findings Associated with Left Occipital Lobe Brain Abscess Following Two Craniotomies Justyna Piszczor, University of Chicago, Chicago, United States Jacqueline Moncivais, University of Chicago, Chicago, United States Jessica Yang, University of Chicago, Chicago, United States Joseph Fink, University of Chicago, Chicago, United States Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses) Keyword 1: infectious disease Keyword 2: occipital lobes Keyword 3: neuropsychological assessment Objective: Brain abscesses (BA) are rare microbial infections of the central nervous system (CNS), with cryptogenic and occipital lobe abscesses being the most uncommon. Patients commonly experience fatigue and cognitive changes after BA removal, regardless of whether by excision and/or aspiration. To our knowledge, only one study has explored the neuropsychological profiles of post-surgical BA patients over several years, though its sample did not include participants with a left occipital lobe lesion. As such, there continues to be a lack of research on post-surgical cognitive sequelae of BA lesions in this particular brain area. Participants and Methods: A right-handed, 87-year-old, Caucasian male presented for a neuropsychological evaluation after experiencing a decline in his memory and attention since undergoing two burr hole procedures 22 months previously for drainage of a BA in the left occipital lobe and splenium. Pre-surgically, the cross sectional measurements of the lesion were approximately 3.5 cm anteroposterior by 3.9 cm transverse by 2.8 cm craniocaudal, and it was found to be in the medial left occipital lobe with progression of hypodense changes across the posterior corpus callosum to the medial right occipital lobe. Post-surgically, there was no evidence of acute intracranial abnormalities. Serial neuroimaging also revealed progressive, mild to moderate, subcortical cerebrovascular disease over a two-year interval, pre- and post-BA drainage. Psychiatric symptoms such as isolation, worry, and rigidity in decision-making were also newly reported following his surgeries. Relevant medical history included Parkinson’s disease (diagnosed 17 months previously), hypertension, hyperlipidemia, hyperthyroidism, chronic insomnia, and cataracts. At the time of the evaluation he was dependent for driving, as well as in managing medications and appointments. Results: His neurocognitive profile was marked by moderate impairments in immediate and delayed memory, as well as recognition paradigms, with some isolated inconsistencies in executive functioning, attention, and language. Visuospatial reasoning and motor functioning were intact. Self-reported depressive symptoms involving apathy, diminished interests, and concentration difficulties were also moderately elevated. Conclusions: The patient’s cognitive profile reflected a diffuse subcortical pattern despite the focal character of his lesion, which is consistent with the current literature examining clinical sequelae of BA lesions in other brain regions. Furthermore, despite the classic phenomenon of “alexia without agraphia” observed with lesions involving the occipital lobes and the splenium, he did not exhibit this constellation of deficits. Similarly, he did not present with prosopagnosia, color agnosia or hemianopia. Thus, the neuropsychological examination did not reveal any focal patterns specific to the abscess region. This case enhances our understanding of the neuropsychological outcomes following neurosurgical treatment in a BA location not yet examined through current literature. Further exploration of this condition is warranted to apply these findings to larger samples and compare them across various neurosurgical methods, as well as to investigate the neuropathological mechanisms for this widespread pattern of neuropsychological deficits.

Poster

02/16/2024
03:30 pm - 04:45 pm
Room: Majestic Complex (Posters 61-120)

Poster Session 09: Epilepsy | Oncology | MS | Infectious Disease

Final Abstract #98

Neuropsychological Findings Associated with Left Occipital Lobe Brain Abscess Following Two Craniotomies

Justyna Piszczor, University of Chicago, Chicago, United States
Jacqueline Moncivais, University of Chicago, Chicago, United States
Jessica Yang, University of Chicago, Chicago, United States
Joseph Fink, University of Chicago, Chicago, United States

Category: Infectious Disease (HIV/COVID/Hepatitis/Viruses)

Keyword 1: infectious disease
Keyword 2: occipital lobes
Keyword 3: neuropsychological assessment

Objective:

Brain abscesses (BA) are rare microbial infections of the central nervous system (CNS), with cryptogenic and occipital lobe abscesses being the most uncommon. Patients commonly experience fatigue and cognitive changes after BA removal, regardless of whether by excision and/or aspiration. To our knowledge, only one study has explored the neuropsychological profiles of post-surgical BA patients over several years, though its sample did not include participants with a left occipital lobe lesion. As such, there continues to be a lack of research on post-surgical cognitive sequelae of BA lesions in this particular brain area.

Participants and Methods:

A right-handed, 87-year-old, Caucasian male presented for a neuropsychological evaluation after experiencing a decline in his memory and attention since undergoing two burr hole procedures 22 months previously for drainage of a BA in the left occipital lobe and splenium. Pre-surgically, the cross sectional measurements of the lesion were approximately 3.5 cm anteroposterior by 3.9 cm transverse by 2.8 cm craniocaudal, and it was found to be in the medial left occipital lobe with progression of hypodense changes across the posterior corpus callosum to the medial right occipital lobe. Post-surgically, there was no evidence of acute intracranial abnormalities. Serial neuroimaging also revealed progressive, mild to moderate, subcortical cerebrovascular disease over a two-year interval, pre- and post-BA drainage. Psychiatric symptoms such as isolation, worry, and rigidity in decision-making were also newly reported following his surgeries. Relevant medical history included Parkinson’s disease (diagnosed 17 months previously), hypertension, hyperlipidemia, hyperthyroidism, chronic insomnia, and cataracts. At the time of the evaluation he was dependent for driving, as well as in managing medications and appointments.

Results:

His neurocognitive profile was marked by moderate impairments in immediate and delayed memory, as well as recognition paradigms, with some isolated inconsistencies in executive functioning, attention, and language. Visuospatial reasoning and motor functioning were intact. Self-reported depressive symptoms involving apathy, diminished interests, and concentration difficulties were also moderately elevated.

Conclusions:

The patient’s cognitive profile reflected a diffuse subcortical pattern despite the focal character of his lesion, which is consistent with the current literature examining clinical sequelae of BA lesions in other brain regions. Furthermore, despite the classic phenomenon of “alexia without agraphia” observed with lesions involving the occipital lobes and the splenium, he did not exhibit this constellation of deficits. Similarly, he did not present with prosopagnosia, color agnosia or hemianopia. Thus, the neuropsychological examination did not reveal any focal patterns specific to the abscess region. This case enhances our understanding of the neuropsychological outcomes following neurosurgical treatment in a BA location not yet examined through current literature. Further exploration of this condition is warranted to apply these findings to larger samples and compare them across various neurosurgical methods, as well as to investigate the neuropathological mechanisms for this widespread pattern of neuropsychological deficits.