1. Communication Breakdown
with Gracie Hobbs and Wayne Daley

2. Situation
Susan, a 35 year-old teacher, has been referred to you from a psychologist who works in your building. She was being treated for depression and mood swings, but now that she has started physical symptoms, the psychologist thinks she needs a neurology consult. Obviously nervous, Susan says, “You might think that I am crazy, but sometimes my hands and feet just seem to move on their own, kind of like they are dancing.” She goes on to say that she remembers her mother experiencing the same thing a few weeks before she died. Sadly, her mother was killed in a car crash before the doctors could ever explore her symptoms. Other than the limb movement, Susan has noticed that she seems to be forgetting little details at work. She has a few bruises on her legs. When asked about them, she tells you that she has been a bit clumsy lately and seems to fall down more than she used to.

3. Symptoms
Susan, a 35 year-old teacher, has been referred to you from a psychologist who works in your building. She was being treated for depression and mood swings, but now that she has started physical symptoms, the psychologist thinks she needs a neurology consult. Obviously nervous, Susan says, “You might think that I am crazy, but sometimes my hands and feet just seem to move on their own, kind of like they are dancing.” She goes on to say that she remembers her mother experiencing the same thing a few weeks before she died. Sadly, her mother was killed in a car crash before the doctors could ever explore her symptoms. Other than the limb movement, Susan has noticed that she seems to be forgetting little details at work. She has a few bruises on her legs. When asked about them, she tells you that she has been a bit clumsy lately and seems to fall down more than she used to.

4. How we diagnosed Susan :
Parts of Brain affected for…
Depression and Mood swings- Frontal Lobe, Hippocampus
Involuntary movement of hands and feet- Motor Cortex
Forgetting little details- Frontal Lobe
Clumsiness- Cerebellum

5. First Possible Medical Problem
We thought that our patients could be experiencing a stroke due to:
Bruising
Memory loss
Clumsiness
But there was also:
Depression
Mood swings
Involuntary movement
Her mother had the same symptoms

6. Second Possible Medical Problem
We also thought that our patient might instead be experiencing a vitamin B-12 deficiency because of:
Depression
Memory loss
Clumsiness
But she didn’t show signs of:
Vision loss
Constipation
Pale skin
Tiredness
Shortness of breath

7. Huntington's Disease
We determined that our patient had Huntington’s Disease which is a genetic defect on chromosome 4 that causes progressive deterioration of nerve cells in the brain
Symptoms of Huntington’s Disease include:
Behavioral awkwardness and moodiness, paranoia, speech impairments, coordination difficulties, involuntary movements, and restlessness
Huntington’s is incurable but there is symptom help

8. Why the communication issue?
Caused by a deterioration of neurons in different sections of the brain
Signals cannot be communicated efficiently
The communication between the body and brain is destroyed and removed

10. What’s Next?
For symptom help Susan now needs to visit a neurologist and therapist to help her…

11. Neurologist
A neurologist assesses the mental health and ability of a patient. They can identify the parts of the brain injured due to her disease and explain why her body is changing and reacting the way it is.

12. Therapist
A therapist, or psychologist, talks with a patient and can help Susan cope and talk through her feelings. They are educated to help people’s mental health and diagnose a more specific mental illness. They can also help with physical health and offer treatment options.