BIOLOGICAL BASIS OF BEHAVIOR

Psychology 321                     	                   
Spring, 2005					HGH 225
Dr. John M. Morgan                 	MWF, 8am to 9:00                                                   

Colloid Cysts, Physical and Personal Impacts on Patient and 
Spouse

Tina Whiting, Humboldt State University


Introduction:

The patient is a 45 year old male who was in a car accident that 
involved alcohol on July 29, 2004.    I have know the patient 
for three years and will be referring to aspects of the patient 
that I know to be true, but am unable to cite  all details due 
to learning them via the dynamics of the relationship.  The 
patient and the patients’ spouse have requested complete 
anonymity for the purpose of this paper.  The car accident 
resulted in a series of injuries for the patient which were a 
fractured pelvis, a lacerated bladder, internal organ bruising, 
a moderate concussion, and sciatic nerve palsy (nerve damage).  
The moderate concussion was determined by a computerized axial 
tomography (CAT) scan which also showed the colloid cyst.  The 
patient believes he was made aware of the cyst; however his 
memories are not absolute and the spouse was not made aware at 
the same time.  The cyst was mentioned (again) at the end of 
September and the brain surgery happened on February 13, 2005, 
six and a half months later.  This series of interviews has 
occurred during the two months after the surgery. (Patient, 
Patient Spouse, personal communication, April, 27, 2005)


Symptoms:

The patient was suffering from intense dizzy spells for a year 
prior to the car accident. The patient is a licensed 
chiropractor and as he put it, “Doctors make the worst 
patients”, so he rationalized the dizziness and never expressed 
a need or desire to medically investigate it.  The patient had 
not been experiencing the most common symptom, a headache.  
(Patient, Patient Spouse, personal communication, April 28, 
2005)  In the literature about colloid cysts there is a high 
prevalence of symptomatic headaches in the patients, often it is 
the headaches the patients are trying to resolve when the 
colloid cyst is discovered. (www.healthcentral.com/encyclopedia)

The car accident fractured the patient’s pelvis so the treating 
physicians rebuilt his pelvis and began physical therapy before 
they scheduled the colloid cyst surgery.  It was at this time 
the patients spouse learned about the cyst; it had been two 
months since its discovery.  After becoming aware of the cyst, 
the patient presented with mild headaches.  (Patient Spouse, 
personal communication, April 28, 2005)


Surgery:

The surgery occurred six and a half months after the CAT scan.  
Despite the suggestion of the nurse and the patient’s partner, 
there was not another CAT scan immediately prior to the surgery.  
The goal of the surgery was to drain the cyst, reroute the 
cerebral spinal fluid and then remove the remaining tissue. 
Prior to the surgery the neurosurgeon was concerned about which 
side of the brain to go through in order to remove the cyst.  
There was extensive questioning about which side of his brain 
was dominant.  These questions were focused on which side of his 
body was dominant; for example, was he most dexterous with his 
right or left hand.  Ironically, the patient is semi-
ambidextrous.  He eats and bats with his right hand, but throws 
and writes with his left hand.  Despite the appearance of this 
ability to use either hand, the neurosurgeons determined the 
patient was right side dominant, thus due to the cross-over 
effect they chose to enter the brain through the left side.  
(Patient, Patient Spouse, personal communication, April, 27, 
2005)

During the surgery there was a complication, the cyst was no 
longer free hanging, and it had tucked up under brain tissue on 
the right side.  When this was discovered the goal of surgery 
changed slightly, rather than removing the cyst, the goal became 
drainage and a shunt in the hopes that it would not return. 
(Patient Spouse, personal communication, May 2, 2005)


Spouse Relationship:

The spouses’ first reaction was one of shock and then she began 
researching colloid cysts immediately on the internet.   She has 
had similar experiences with people in her life having brain 
tumors and aneurisms.  Her immediate concerns were impacted by 
her research and the information given to her by the doctors.  
Primarily, she was concerned that the cerebral spinal fluid flow 
would be stopped by the cyst and her partner could die 
immediately.  Other concerns she had were if the cyst is 
reoccurring, if there would be a need for multiple surgeries, 
memory loss (both short term and long term) and that his 
personality would be altered. (Patient, Patient Spouse, personal 
communication, April, 27, 2005)

Prior to the patient’s surgery, the relationship changed 
dramatically, due to the car accident.  The relationship became 
stronger due to the toll of  such a traumatic event, the 
patients spouse spent nearly all of her free time at the 
hospital and the patient had an excessive amount of time for 
self reflection, in which he discovered an inner strength and 
gratitude for those people who made the effort to support him.  
The brain surgery magnified this effect in the relationship and 
the patient and his spouse are enjoying a more open and 
satisfying relationship.  (Patient, personal communication, 
April, 27, 2005)


Impacts: Memory, Personality, Employment

Immediately following the brain surgery, the patient has little 
or no memory of daily events.  When asked what a typical day was 
immediately after the surgery the patient searches his memory 
and comes up with guesses of what his days were like.  According 
to the patient’s spouse, he had severe memory loss for several 
weeks post surgery.  This memory loss included both short term 
and long term memories.  For example, the patient moved six 
months prior to the car accident and after the surgery he could 
not recall the new address or phone number.  This presented some 
difficulties in everyday life; however, a system of notes was 
utilized by the patients spouse in order to relieve the 
patients’ daily panic.  The notes at first were placed in key 
locations in the residence with pertinent data on them such as, 
information about the accident, the surgery, his driving status, 
and what he would need to do daily.  To support this 
information, the spouses’ adult children and other relatives 
would spend their days with him. (Patient, Patient Spouse, 
personal communication, April, 27, 2005)

The patient is an instructor at a local community college in the 
San Diego area and returned to his teaching job ten days post 
surgery.  The institution was made aware of the patient’s 
condition and fully supported his immediate return to work.  The 
patient team teaches with another instructor who also supported 
his return to work.  The patient would go to work, begin his 
class and the team instructor would leave the room for the 
period.  Apparently the information that was being taught to the 
students was stored in a different area of the cortex, because 
the patient did fine at teaching the students.  So fine, in 
fact, that a student who was unaware of the patients’ condition, 
approached him recently and was surprised to hear about the 
surgery.  The patient is currently not allowed to work as a 
chiropractor yet due to liability issues.  (Patient, Patient 
Spouse, personal communication, April, 27, 2005)

The patients’ compromised memory made for interesting events.  
One evening the patient and his spouse went to play trivia at a 
mutual friend’s house.  At the house all the trivia players were 
introduced to each other.  There was an individual in attendance 
from New Zealand with a unique accent.  Every time the patient 
heard this individual speak, he asked him where his accent was 
from.  The individual would tell him and the patient would 
inquire about his stay in the United States and other 
conversational information.  After the brief conversation the 
patient would return his focus to the trivia game.  This 
happened several times throughout the evening.  The New 
Zealander learned of the situation and was very gracious.  The 
patient prior to surgery was very useful as a trivia team 
member, recalling random bits of information rapidly and easily, 
and this had not changed post surgery.  However, he could not 
recall asking the New Zealander about his accent several times.  
Even so recent as the phone interview the patient recalls going 
to trivia but not the details of the evening.  Patient, Patient 
Spouse, personal communication, April, 27, 2005)

The patient has recovered some of his memories, but still lacks 
a large quantity of detail information.  He currently recalls 
his new address and phone number with little hesitation which he 
was not able to do immediately post surgery.  Prior to surgery 
the patient was in constant excruciating pain due to the 
reconstruction of his fractured pelvis and physical therapy.  
After the surgery, according to the patients’ spouse, the 
patient was in absolutely no pain for approximately a week and a 
half, and then the pain returned gradually.  The patient is 
unable to recall the time immediately post surgery with any 
clarity and can not say if he felt any pain during that time. 
(Patient, Patient Spouse, personal communication, April, 27, 
2005)

The patient expressed great frustration at his memory loss.  He 
also expressed a sense of betrayal by his memory and memory 
processes.  He describes his current actions as “deliberate” and 
purposeful.  An example is how he prepares for his classes.  He 
described his teaching style before the surgery as fairly 
relaxed; he didn’t spend a large amount of time preparing his 
lectures or being concerned about forgetting any information.  
Currently, the patient spends more time preparing and is fearful 
of forgetting a portion of his lectures.  He describes his 
memory as a safety net that he no longer has.  Recently, a 
student asked him a question that was slightly off topic so he 
wasn’t prepared for it; however, he was able to answer it 
without a hitch.  It is this ability he lacks confidence in.  In 
our conversation I asked if he felt he needed to rebuild 
confidence in the memory and recall relationship of his brain 
and he agreed enthusiastically. (Patient, Patient Spouse, 
personal communication, April, 27, 2005)

The literature covers personality differences in people who 
survive colloid cysts.  The patient does not perceive a 
personality change, however his spouse and myself both do.  His 
spouse says he is mellower, less excitable; he does not 
physically sweat as much, and has a new affinity for the roses 
in the yard.  During my conversations with the patient prior and 
post surgery there is a noticeable difference in his 
communication.  He used to be a great storyteller, just 
volunteering the details and expanding the story in order to be 
as complete and detailed as possible.  Currently, he did not 
demonstrate a desire to proliferate, he was friendly and capable 
of responding to questions easily, however, the rich detail of 
the stories was missing.  He did tell me about the roses and I 
was humored by his fondness for the flowers.  I had never heard 
him discuss any flowers in the past much less with such 
enthusiasm.  (Patient, Patient Spouse, personal communication, 
April, 27, 2005)

When asked about experiencing an epiphany about life after the 
accident and surgery the patient said that he indeed have an 
epiphany about his life.  He treasures his relationships and 
takes nothing for granted.  He also has a new found self-respect 
due to the hard work of overcoming the injuries to not only his 
brain, but his body as a whole.  Of his spouse he speaks with 
reverence about her endless patience, kindness and love.  
(Patient, Patient Spouse, personal communication, April, 27, 
2005)


Works Citied:

Intensive Interview with Patient (April 27, 2005)

Intensive Interviews with Patient Spouse (April 28, 2005)May 2, 
2005)


Neurologist and Neurosurgeon: A Case Study of a Colloid Cyst. 

Erica Heuer, Humboldt State University
 

Introduction:

Colloid cysts in the third ventricle of are very rare 
intracranial benign tumors. The cysts are located deep inside 
which makes treatment of the tumor very difficult.  It takes a 
team of skilled professionals to treat patient with these kinds 
of cysts.  The two people that I will be focusing on are the 
Neurologist and the Neurosurgeon even though there are whole 
teams of people that specialize in neurosurgery and that see to 
the patients care pre and post operation.      


The Role of the Neurologist:

The role of the Neurologist is to diagnose and come up with a 
plan of action for the patient, depending on what is wrong with 
the patient.  The Neurologist can order test for the patient to 
see what is wrong and what needs to be done.  These tests can 
include but are not limited to blood test, CT scan, or MRI scan.  
The Neurologist works with the Neurosurgeon and instructs him or 
her on what to do during the surgery.  

Patient can get referred to Neurologist for many reasons but 
most often the patient symptoms are intracranial pressure 
(headaches) and/ or dizzy spells. Common signs of a colloid cyst 
are short-term memory interruptions and papilledema.  
Papilledema is swelling of the optic disk where the optic nerve 
enters the eyeball. The optic nerve is responsible for carrying 
virtual impulses to the brain.  

Based on the symptoms of the patient the neurologist will order 
test to find out what is going on.  A Magnetic Resonance Imaging 
(MRI) is one way of diagnosing.  Most of the brain and central 
nervous system problems are diagnosed through the use of a MRI.  
MRI creates an image using nuclear magnetic resonance and is 
possible because the human body is filled with small biological 
magnets. (See figure 1, normal brain during MRI)
  
In the case of the patient he never saw a neurologist because 
his colloid cyst was found during a routine CAT scan following 
his accident.  However the patient was suffering from dizzy 
spells prior to surgery.   

For patients with a colloid cyst the most common plan of action 
is surgery, which is preformed about 93% of the time.  The two 
method used most often are Transcallosal and 
transcortialtransventricular. Out of the 105 patients in the 
study 62 patients had a Transcallosal and 30 patients had 
transcortialtransventricular.  The data shows that the outcome 
of the patients is about the same no matter which procedure is 
used.  
 

The Role of the Neurosurgeon:

The neurosurgeon performs Neurological surgery on the brain or 
spinal column. The surgery can include excising, or cutting out, 
brain tumors and removing ruptured discs in the spine, an 
operation known as a laminectomy. The neurosurgeon uses imaging 
equipment such as CT and MRI to see what the exact location of 
the tumor.  Knowing where the tumor is enables the surgeon to 
remove the growth with the least amount of damage to the rest of 
the brain. Small percentages of the tumors that a neurosurgical 
team sees are colloid cyst because they are so rare.  One 
hospital, Royal Price Alfred, neurological team only saw 1.6% of 
patients with colloid cyst out of all of the neurological 
surgery done at the hospital.    

In the case of the patient he had two neurosurgeons who were 
both affiliated with University California, San Diego. The 
surgeons and the patient had a consultation prior to surgery 
where the neurosurgeon made their recommendation.  The plan was 
to drain the colloid cyst, reroute the cerebral Spinal Fluid and 
then remove the tissue.  In the case of the patient a problem 
came up in that the time of the CAT scan the cyst was hanging 
freely in the third ventricle of the brain.  During the time 
between the CAT scan and the operation the cyst had moved and 
tucked up under the frontal lobe.   Do to this the neurosurgeons 
where only able to drain and remove part of the colloid cyst.  
The hope of the neurosurgeons is that they remove enough of the 
cyst so that it will not grow back. The surgeon entered the 
brain through the right frontal lobe making a hole about the 
circumference of an ink pen. The surgery lasted about 2 ½ hours 
and left the patient with an (S- shaped) scar about 2-3 inches 
long. 

Following removal of a colloid cyst in the third ventricle 
patient can have a number of complications.  In one longitudinal 
case study two patients developed anterograde amnesia.  This 
impairs a person’s ability to lay down new memories, which is 
cased by damage to the area of the brain that deals with long-
term memory, including the hippocampus, the temporal lobes, and 
the frontal lobes.  A person with anterograde amnesia might 
spend an entire day with a person and then not recognized that 
person.  In a different study of 105 patients with colloid cyst 
76 of the patients showed enlarged lateral ventricular.  16% 
percent of the patients had memory problems following the 
surgery.   


In conclusion:

Research is continual being done to improve outcome and overall 
quality of life for the patient. Even though colloid cysts are 
benign tumors (non-cancerous) they pose many problems and are 
difficult to remove surgically because of their location.  
Patient in which the tumor is found and removed early have a 
better prognoses then those that do not.  

Microsoft® Encarta® Reference Library 2003. © 1993-2002 
Microsoft Corporation. All rights reserved.


Neuropsychological and Employment Implications: A Case Study of 
Whiting’s Patient

Brian Godwin, Humboldt State University


Introduction:

In 2005, the case study patient was involved in an automobile 
accident, where he sustained a head injury (Whiting, 2005). 
During a routine CT scan to check for possible brain damage, his 
physicians discovered an abnormal growth within his third (3rd) 
ventricle, in the approximate region of the frontal lobe. The 
physicians later determined that the growth was a colloid cyst, 
which is a collection of gelatinous material. On the advice of 
his physicians, the patient underwent neurosurgery to have the 
cyst removed, and recovered without any serious side effects.

The diagnostics, treatment, and follow-up care associated with 
brain surgery are not performed in a vacuum; rather, the 
appropriate level of pre-operative and post-operative care 
relies on the deliberate cooperation of various parties.  These 
parties include the neurologist, the neurosurgeon, the 
psychological and psychiatric professionals, the patient’s 
spouse, his or her employer, and the patient her or himself. The 
intent of this paper is to examine the roles of the 
neuropsychologist and the patient’s employers in the successful 
treatment, using the case study of the patient as a vehicle to 
conduct this analysis. This paper will begin with a brief 
overview of the frontal cortex and the 3rd ventricle, followed by 
the viewpoints of the neuropsychologist and the patient’s 
employer.


The Frontal Cortex: A Brief Overview

The brain’s outermost covering, the cerebral cortex, is 
partitioned into four lobes: the occipital lobe, the parietal 
lobe, the temporal lobe, and the frontal lobe. Although these 
lobes, as well as the rest of the brain, mutually innervate each 
other, each particular lobe is associated with different aspects 
of behavior and information processing (Drubach, 2000). The 
occipital cortex contains much of the neurons used in the 
processing of visual images, the temporal lobe processes many 
components used in the understanding of language, and the 
parietal lobe contains the primary somatosensory cortex, the 
cortical structure involved in the processing of touch 
sensations and muscle and joint data. (Kalat, 2001) 

Of interest to us is the frontal lobe. It extends from the 
central sulcus (a deep cortical groove extending along the 
coronal plane to both hemispheres of the brain) to the anterior 
limits of the brain. The two main divisions of the frontal lobe 
are the primary motor cortex and the pre-frontal cortex. The 
latter structure, the primary motor cortex, is responsible for 
the coordination of fine motor movements throughout different 
parts of the body; its geographic layout, known as the 
homunculus, controls the specific parts of fine motor movement 
throughout the body. (Kalat, 2001)

The prefrontal cortex is thought to be responsible for a set of 
intellectual processes known collectively as executive 
functions; these include, but are not limited to, planning, 
working memory, and attention shifting (Goldberg, 2001). Case 
studies from prefrontal lobotomies, where the prefrontal cortex 
is surgically severed from the rest of the cortex, also reveal a 
pronounced blunting of emotional responses and affect in the 
patients (Kalat,2001). This data indicates that the prefrontal 
cortex plays an instrumental role in the formation of emotion, 
as well as that of personality.

In regards to the case the patient, the frontal lobe itself was 
not directly affected by the colloid cyst, as the cyst was 
located in the 3rd ventricle (Whiting, 2005). Damage sustained, 
however, by effects from unchecked cyst growth or surgical 
mistakes would have no doubt caused damage to areas of the 
frontal lobe, which probably would have impaired some of its 
functions.


The Third Ventricle:

The brain contains four fluid-filled channels known as the 
ventricles, which are the brain equivalent to the central 
channel of the spinal cord (Drubach, 2000; see also Kalat, 
2001). The ventricles circulate a clear fluid known as 
cerebrospinal fluid (CSF), which supplies the brain with various 
nutrients, acts as a reservoir for hormones, and provides fluid 
shock absorption and support for the brain (Kalat, 2001). Each 
hemisphere houses a lateral ventricle, which then flows out of 
the brain via the third and fourth ventricle respectively 
(Kalat, 2001).

In the case of the patient, damage caused by a colloid cyst in 
the third ventricle could potentially interfere with the 
hormonal release of the pineal gland. Also, surgical mistakes 
could affect the frontal cortex as well, disrupting its 
functioning.


The Role of the Neuropsychologist:

The role of the psychiatric and psychological practitioners in 
the event of brain surgery is to deal with various behavioral 
and emotional changes occurring in the patient. Such changes are 
statistically common in patients undergoing neural surgery to 
remove brain tumors and cysts. 

According to the National Academy of Neuropsychology (2001), a 
neuropsychologist is psychologist with “...specialized expertise 
in the applied science of brain-behavior relationships. 
[These][c]linical neuropsychologists use this knowledge in the 
assessment, diagnosis, treatment, and/or rehabilitation of 
patients across the lifespan with neurological, medical, 
neurodevelopmental, and psychiatric conditions, as well as other 
cognitive and learning disorders” (p. 22). By integrating 
various psychological, medical, cognitive, and behavioral tests, 
the neuropsychologist determines the appropriate level of care 
for the patient. This care would range anywhere from simple 
cognitive rehabilitation tasks, such as memory strengthening, to 
coordinating with psychiatrists a strict medicine regime to 
promote healing. To use a metaphor regarding the brain, the 
neuropsychologist can be thought of as the “hypothalamus” of the 
post-operative recovery team, in that he is responsible for 
integrating the various sets of incoming information.

Regarding the patient, a neuropsychologist would have to be 
particularly sensitive to deficits associated not only with 
general brain surgery, but also that of frontal lobe trauma. 
Given that colloid cyst removal surgery almost always involves 
microsurgery, usually involving endoscopic aspiration and 
excision, the neuropsychologist would not have to anticipate any 
effects associated with radiological treatment, such as 
persistent nausea and vomiting (Amy and Walker, 2003; Bell et 
al, 1998). The most common side effects that brain surgery 
patients complain about are headache, followed by motor 
impairment. This motor impairment, according to Bell et al 
(1998), can include “…dysphagia, ataxia, and apraxia,” physical 
conditions that the neuropsychologist can anticipate and prepare 
the patient for during both pre-operative and post-operative 
interactions (p.s-42; see also Socin et al, 2002). Accordingly, 
a rehabilitation schedule focusing on strengthening psychomotor 
function should be implemented, or a contingency involving the 
implementation thereof, by the neuropsychologist.

The neuropsychologist should also be mindful of the 
psychological consequences of brain surgery. Many patients 
having brain tumors removed experience anxiety and/or depression 
in the weeks following their surgery (Bell et al, 1998). If not 
adequately addressed by the patient’s mental health 
practitioner, these emotional disturbances may also adversely 
impact the patient’s cognitive rehabilitation (Bell et al, 1998; 
Amy and Walker, 2003). Furthermore, these emotional disturbances 
may exert an impact upon the patient’s families and immediate 
caregivers, creating potential deficits in the standard of post-
operative care (Bell et al, 1998). In the patient’s case, the 
tumor was situated in near-proximity to the frontal lobe; damage 
to this area could entail disruptions in the patients working 
memory, as well as changes in his attention shifting ability 
(Kalat, 2001). It would be prudent, then, for the 
neuropsychologist to incorporate cognitive-behavioral 
treatments, such as the use of notepads and digital timers, that 
help the patient compensate for his or her diminished capacity 
within these areas (Billetteri, 1997; see also Bell et al, 
1998).

The neuropsychologist is responsible for researching the 
possible consequences of a brain surgery, and then preparing the 
patient, as well as other members of the treatment team. By 
doing so effectively, potentially threatening side effects are 
accounted for, thereby lowering the probability that the post-
operative recovery will be unsuccessful.


The Employer and the Social Worker:

In addition to the immediate members of a brain surgery 
patient’s treatment and recovery team, other people are affected 
by the brain surgery process. Both pre-operative and post-
operative issues concern the patient’s employer.  The following 
sections will address the employer’s and social worker’s 
concerns regarding federal requirements and work-place issues.


The American with Disabilities Act:

In 1991, President George H. Bush signed the American 
Disabilities Act (ADA) into law (Griffin, 1991). It was a 
refinement of the Rehabilitation Act of 1973, which prevented 
discriminatory hiring practices against persons with 
disabilities within agencies receiving federal funding.  Title I 
of the ADA extends this prohibition of discrimination to all 
employers, meaning that a person cannot be denied employment, 
nor can he or she be terminated from his or her current 
employment on the sole basis of having a disability (US 
Department of Justice,2002). Furthermore, the law also requires 
that an employer take steps to afford “reasonable accommodation” 
for a disabled person in regards to their work place environment 
(Worsnop, 1996; Department of Justice, 2002). Such 
accommodations may be physical in nature, such as the 
installation of a wheelchair ramp, or they may involve altering 
practices such as scheduling and performance reviews (Worsnop, 
1996). 

The patient did not require any physical accommodations 
following his surgery (Whiting, 2005). As noted above, had the 
patient suffered any of the psychomotor deficits that can occur 
as a result of frontal lobe injury; he did, however, encounter 
serious problems with his short term memory as a result of his 
surgery. His employer, a public agency within the state of 
California, would have been therefore obligated to take 
reasonable action to accommodate his memory deficits (US 
Department of Justice, 2002; Worsnop, 1996). These 
accommodations could be broad in scope, such as allowing him to 
use an audible timer reminding him to consult written schedules 
and notes, are often little or no cost to the employer (US 
Department of Justice, 2002; Worsnop, 1996; Billitteri, (1997). 
Additionally, had The patient needed a lengthy convalescent 
period (he did not; he was back to work in seven days), his 
employers would have been bound by the Family and Medical Leave 
Act of 1993 to grant him up to 12 weeks of unpaid leave to 
recover (Rupe,2004). 

It is also prudent to note that the employers must balance the 
liability towards the company against the rights of the patient. 
Although the ADA mandates that employers take reasonable steps 
to accommodate disabilities, they must also weigh this against a 
judgment of whether or not, with respect to accommodations, the 
newly disabled patient can adequately and safely perform his or 
her job duties (Worsnop, 1996; Rupe, 2004)). Had the patient’s 
memory deficits posed a liability, financial or otherwise, to 
his company and those it serves, his company would not have been 
bound to continue his employment. Thus, the employer must work 
within the framework of the ADA and FMLA to make a judgment on 
whether or not a disability can be accommodated. 

Had this situation ensued, or had the patient been illegally 
discriminated against due to his disability, The patient would 
have had to invoke the services of a social worker. This person 
would have been responsible for securing the patient access to 
various resources, including disability monies and legal 
services to investigate any breaches of federal law (Billitteri, 
1997; Bell et al, 1998). The social worker would have had to 
coordinate therapeutic interventions that The patient required 
with both himself and with his family. As we can see, the 
patient’s surgery, or any surgery that results in brain 
alterations, requires a concentrated effort not only on the part 
of the patient’s medical workers, but also on his employers and 
the social workers assigned to his case. 


Conclusion:

Frontal lobe damage caused by a colloid cyst, and indeed brain 
tumors in general, present some serious challenges for a 
patient’s neuropsychologist and his or her employer. 
From the neuropsychologist’s standpoint, it is imperative that 
any cognitive, motor, and behavioral deficits subsequent to the 
surgery, so that various therapies and treatment can be utilized 
in order to minimize their effects. The employer must also be on 
the ready to work with both the patient and his or her social 
worker, so that every reasonable effort can be made to 
accommodate any unexpected disabilities resulting from the 
surgery. 
 


Works Cited:

Amy, C., and Walker, E. (2003). Not just another headache: 
Colloid cyst of the third ventricle. The Nurse Practitioner, 28, 
pp.8 and 12. Retrieved April 18, 2005 from EBSCO database.

Bell, K., O’Dell, M., Barr,K., and Yablon, S. 
(1998).Rehabilitation of the patient with a brain tumor. Archive 
of Physical Medicine and Rehabilitation, 79, pp. S-45 to S-46. 
Retrieved April 18, 2005, from ScienceDirect database.

Billitteri, T. (1997). Mental health policy. The CQ Researcher, 
September 12. pp.793-816.

Drubach, D.  (2000). The brain explained. Upper Saddle River: 
Prentice Hall Health.

Goldberg, E.( 2001). The executive brain. New York: Oxford 
University.

Griffin, R. (1991). The Disabilities Act. The CQ Researcher, 
December 27, pp.993-1015.   

Kalat, J. (2001). Biological psychology. Belmont: Wadsworth-
Thompson.

National Academy of Neuropsychology (2001). Policy statement: 
Definition of a neuropsychologist. Retrieved April 18, 2005, 
from National Academy of Neuropsychology: 

Rupe, A. (2004). Six ways to get yourself sued. Workforce 
Management, November, pp.6-18. Retrieved April 18, 2005, from 
JSTOR database.

Socin, H., Born, J., Wallemacq, C., Betea, D., Legros, J., and 
Beckers, A. (2002). Familial colloid cyst of the third 
ventricle: Follow up and review of the literature. Clinical 
Neurology and Surgery, 104, pp. 367-370.

U.S Department of Justice (2002). A guide to disability rights. 
Retrieved on April 18, 2005, from  
http://www.usdoj.gov/crt/ada/adahom1.htm

Worsnop, R. (1996). Implementing the Disabilities Act. The CQ 
Researcher, December 20, pp.1105-1128.

Whiting (2005). Colloid Cysts, Physical and Personal Impacts on 
Patient and Spouse. UNPUBLISHED MANUSCRIPT. 

Copyright © 2005, Dr. John M. Morgan, All rights reserved - This page last edited 1-3, 2005
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