a. 45 yr old right handed married white female restrained driver hit at moderate speed from the passenger side by another car.

b. Studies included a normal brain CT, MRI and non focal emergency neurological exam. Diagnosis mild TBI.

c. Clinical problems have included the following areas;

        1. Cognitive- forgetfulness, decreased attention with
            listening skills, decrease organization and recall

        2. Emotional- loss of social confidence, daily anxiety.

d. SPECT imaging findings showed the following changes
            in perfusion;

        1. in the concentration study there is a very significant
            decrease in the right superior Parietal lobe, a
            moderate decrease in the left inferior Frontal cortex
            and both Basal Ganglia.

        2. in the resting study there is also a decrease in the
            right Frontal pole that extends to the inferior Frontal
            cortex and same region of the right Parietal lobe.
            Additionally, there is a very significant focal increase
            in the Thalamus

e. SPECT study demonstrates significant focal decrease along the right superior Parietal lobe in the activation and baseline condition, a focal significant increase in the Thalamus in both studies.

f. Treatment response to brief trial of stimulant was immediate improvement in short term memory but developed mania within 3 days. Panic occurred after the first dose of SSRI medication. She continues on high dose Amino Acid supplements and works closely with a TBI case support professional using notebooks and systems to remind her as she show signs of recovery