We aim to highlight a unique case that required adaptation of a neuropsychological battery used as part of a pre-surgical workup for medically refractory epilepsy, to meet the needs of a culturally and linguistically-diverse patient with visual impairment.

Comprehensive pre-surgical neuropsychological evaluation for a 34-year-old Spanish-speaking patient with a past medical history of epilepsy, hydrocephalus, and a subependymal giant cell astrocytoma resection, with subsequent complete blindness. EEG findings demonstrated abnormal left frontal dysfunction. A neuropsychological evaluation was conducted utilizing components from the Neuropsychological Screening Battery for Hispanics (NeSBHIS) as well as additional supplemental Spanish language assessments. Due to the patient’s visual impairment, visuospatial measures were unable to be utilized. Hand dynamometer was used in place of the Grooved Pegboard Test.

Results from the evaluation indicated a generally intact cognitive profile with a few observed deficits. Relative and normative weaknesses were identified on tasks of verbal learning. His initial learning of a list of orally presented words was in the Low Average range, where he demonstrated a positive though somewhat flat learning profile. His performances on short- and long-delay free recall tasks were in the Exceptionally Low range. With a recognition format, he performed within normal limits and made no false positive errors. Importantly, during the initial learning of the word list, the patient demonstrated a significant number of repetitions (13) and semantically related intrusions (6). These likely led to downstream difficulties encoding information; however, he displayed a minimal loss of information over a delay. Similarly, his immediate and delayed recall of an orally presented story fell in the Exceptionally Low range. Additional relative weaknesses were observed on tasks of working memory (Low Average range) and on a task of phonemic fluency (Below Average range). This performance was a notable contrast to his performance on tasks of semantic fluency, which ranged from the Low Average to Average range. On a task of motor functioning, grip strength performances were intact bimanually (Low Average to Average range) without a significant asymmetry between his left and right hands. Lastly, formal assessment of emotional functioning on self-report measures revealed minimal depression, minimal anxiety, and no significant quality of life concerns.

Taken together, the weaknesses observed in the domains of verbal learning, working memory, and phonemic fluency, in addition to the learning profile observed during the verbal encoding task, suggest that his overall profile is indicative of dominant frontal systems dysfunction. This finding was concordant with prior EEG and MRI studies. Notably, given the patient’s visual impairment, visuospatial measures were unable to be utilized, and lateralization was unable to be fully assessed given the abbreviated battery. The neuropsychological battery used for this evaluation was based on established guidelines, and while there were limitations in administration of the present battery, it is imperative to highlight the necessity and feasibility for adaptation of protocols to best capture data in culturally-underrepresented and visually impaired populations.