B-103: Neuropsychological Functioning in a Complex Case Study of Hypoxia, Wilson’s Disease, and Trauma

Abstract

Objective: Complex neuropsychiatric presentations often reflect the interaction of multiple risk factors rather than a single underlying condition. This case examines how early hypoxic injury, metabolic dysfunction consistent with Wilson’s disease, and chronic trauma exposure converge to influence cognitive and emotional functioning in adulthood and contribute to clinically significant variability in performance. Method/Data Selection: The patient is a 34-year-old bilingual woman with a history of congenital cardiac complications associated with hypoxia and a later diagnosis of Wilson’s disease. Her clinical course includes longstanding attentional difficulties, mood instability, multiple psychiatric hospitalizations for psychosis, and cannabis use. Additional contributing factors include chronic sleep disruption. A comprehensive neuropsychological evaluation was conducted in an outpatient setting, including the Wechsler Abbreviated Scale of Intelligence–Second Edition (WASI-II), Wechsler Adult Intelligence Scale–Fourth Edition (WAIS-IV), Woodcock Johnson Tests of Achievement, Beery-Buktenica Developmental Test of Visual-Motor Integration, Grooved Pegboard Test, Rey Complex Figure Test, Wechsler Memory Scale–Fourth Edition (WMS-IV), Delis-Kaplan Executive Function System (D-KEFS), California Verbal Learning Test–Third Edition (CVLT-3), and Minnesota Multiphasic Personality Inventory–Third Edition (MMPI-3). Results/Data Synthesis: Findings revealed superior intellectual functioning alongside marked intra-individual variability. Weaknesses were observed in processing speed, working memory, executive control, and visuomotor coordination. Memory performance was inconsistent under increased cognitive demand, reflecting reduced encoding and retrieval efficiency. Socioemotional functioning was notable for hypomanic activation, anxiety, and behavioral dysregulation. Diagnostic impressions include Bipolar II Disorder, Attention-Deficit/Hyperactivity Disorder, Posttraumatic Stress Disorder, and Cannabis Abuse Disorder. Conclusions: This case highlights the cumulative impact of neurodevelopmental disruption, subcortical dysfunction, and trauma-related neurobiological changes, emphasizing how cognitive reserve may mask deficits while contributing to functional impairment.