a.       20 year old right handed male sustained a skull fracture from a fall involving the left Temporal bone with a resultant epidural hematoma and unconsciousness for an unknown period of time. His non depressed skull fracture was treated surgically. A three month post hospital rehabilitation course helped him to walk again.

b.      Studies showed the left sided skull fracture along with a sleep study remarkable for narcolepsy findings. His neuropsychological testing revealed below average reading and math fluency, average attention and above average memory testing with low processing speed.

c.       Clinical problems initially included personality changes of increased irritability and vertigo but evolved into concerns with forgetfulness, anxiety with easy overwhelm and daytime fatigue ( narcolepsy ).

d.      Litigation is ongoing.

e.       SPECT studies revealed a focal decrease in the right inferior Frontal and left medial Temporal lobe in both baseline and activation study and a significant increase in the left Caudate in the baseline study.

f.        Treatment has included a combination ongoing psychotherapy and  SSRI medication for anxiety, Modafanil for narcolepsy and stimulant medication for processing speed.