a. 40 year old right handed female that fell from a horse and suffered a concussion. This was her fifth concussion- fall in five years and she had a prior history of other concussions and emotional abuse.

b. Studies have included normal brain MRI's, abnormal QEEG with asymmetry, irregular coherence, abnormal sleep study with a decrease in slow wave sleep. Neuropsychological testing showed impairments with complex attention, processing speed, set shifting and moderate impairment with verbal memory and math fluency.

c. Clinical problems have included the following;

1. Somatic complaints of daily headaches, dizziness and nausea.

2. Emotional complaints of moodiness

3. Cognitive complaints of decreased mental slowness at work, multi-tasking and excessive daytime fatigue that requires naps.

d. No litigation has been filed.

e. SPECT studies demonstrated the following perfusion changes;

1. in the concentration study there is a global decrease in both hemispheres extending from the anterior Frontal pole posteriorly to the Parietal and Occipital lobes. There is a very significant focal increase in the Thalamus.

2. in the resting study there is a patchy decrease across the Frontal lobes and a similar decrease noted in the Parietal lobes. The Thalamus shows a focal increase as seen in the concentration study.

f. Treatment with Modafanil for fatigue caused headaches, Galantamine for processing speed and memory caused nausea. Sodium Oxybate was added for sleep problems and improved daytime fatigue. High dose amino acid supplement was added for mood changes, Neuro and Cys Replete.