THE USE OF NEUROPSYCHOLOGICAL DATA TO DETECT ALTERED NEUROLOGICAL FUNCTIONING IN A CHILD WITH MYELOMENINGOCELE

Although children with myelomeningocele often display atypical pattern s on psychometric testing, this case study demonstrates the sensitivit y of neuropsychological instruments to detect altered neurological fun ctioning in a patient with spina bifida. The subject had a history of myelomeningocele at the lumbosacral level and placement of a ventricul operitoneal shunt. During a routine neuropsychological evaluation, a 4 4-point discrepancy between his verbal (verbal IQ = 98) and nonverbal abilities (performance IQ = 54) on the Wechsler Intelligence for Child ren-Revised was found. In comparison to high average academic achievem ent, test findings suggested depressed memory skills and extreme slowi ng in psychomotor speed. A pattern of acute decline in overall cogniti ve functioning was suggested. Magnetic resonance imaging revealed a le ft frontoparietal brain mass, which was surgically removed. Follow-up neuropsychological testing 9 months postsurgery indicated an increase in nonverbal intelligence with improved psychomotor speed and informat ion processing. This case study illustrates the importance of obtainin g baseline evaluations in this neurologically high-risk population as well as the clinical usefulness of psychometric data in diagnostic wor kups.