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