a.       40 year old right handed female involved in a motor vehicle accident as a restrained driver with seat belt only ( no shoulder harness ) hit from behind several times by a larger vehicle. She hit her head on the windshield , experienced a brief confusional episode without clear loss of consciousness

b.      No abnormalities were found on brain MRI despite orthopedic complaints requiring physical therapy. An Osteopathic assessment determined that a whiplash type of injury with damage to the cervical ligaments was the cause of the neck complaints. Neuropsychological testing initially determined that an overlap of findings ranged from depression to concentration difficulties that may have been due to developmental dyslexia with personality style. Repeat testing one year later found a significant impairment with non-verbal memory. Testing a third year later  confirmed executive level problems with set shifting, attention impairments including decreased vigilance, difficulty comprehending verbal and non-verbal concepts including impairment with reading fluency and comprehension.

c.       Clinical complaints initially included problems sustaining attention at work as an office secretary with frequent forgetfulness, anxiety attacks, sadness, fatigue, dizziness, headaches and blurred vision.

d.       Litigation resulted in a disability settlement. She was discharged from her work.

e.       SPECT imaging demonstrated a mild to moderate decrease in activity in the dorsal Frontal and mid-superior Parietal region in both studies. Additionally, a significant increase in the Thalamus was seen in both studies. These findings suggest a deficit in Frontal lobe functioning along with a depressive disorder.

f.        Treatment has included cognitive rehabilitation, maintenance of antidepressant medication, stimulant medication, rivastigmine, modafanil and amantadine. Support therapy and regular visits continue.