Monday Evening, Case 3

This a referral from a local rehabilitation hospital. The patient is a 61 year old gentleman who had a recent myocardial infarction while at work as a computer programmer. Someone at work attempted CPR and started chest compressions. When the EMTs arrived an external defibrillator was repeatedly used in order to restart his heart. After 25 minutes and five shocks with the defibrillator, a cardiac rhythm was reestablished; unfortunately, the patient's brain had been hypoxic for an extended period of time. The physical effects of this incident were minimal (no paralysis or motoric weakness), the cognitive effects; however, were profound. Upon meeting the patient the patient's mental confusion was very evident. He had a bewildered expression on his face, and his eyes darted around the hospital room attempting to make sense of his current situation and surroundings. I introduced myself to him and he said "Who's Dr. AH?" I said "I am." He responded "Who's Dr. AH?" This exchange happened so many times that it became an Abbott and Costello routine ("Whose on first?"). The clinical interview revealed an individual with severe receptive and expressive aphasia, impaired short-term memory, distractibility, dyslexia without dysgraphia, and either prosopagnosia or a visual apperceptive agnosia. He also exhibited an environmental dependency syndrome, temporal disorientation, and geographical disorientation. He was unable to recognize members of his family, he kept taking off his portable external defibrillator; and he would raise objects up to his nose and sniff them intently, apparently trying to determine what the objects were and if they were edible. When shown a photograph of a recent family reunion, he was unable to recognize himself. "Who are these people?" he asked.