a. 60 year old right handed male involved in a motor vehicle accident as an unrestrained driver hit from behind. He sustained a forehead laceration and concussion requiring hospitalization.

b. Studies included normal brain MRI and cervical MRI. Neuropsychological testing showed selective reading impairment, average memory function, low processing speed and confusion on executive measures.

c. Clinical problems included:

1. Somatic complaints of neck and back pain

2. Emotional complaints of anticipatory anxiety over return to work, social anxiety, sadness.

3. Cognitive problems with slowness in planning, daily forgetfulness with planning and management.

4. Litigation is ongoing.

d. SPECT imaging studies demonstrated the following perfusion changes;

1. a focal decrease in the posterior Parietal lobe, left more than right.

2. a very significant focal increase in the Thalamus and moderate increase in the Caudate bilaterally.

e. Treatment has included weekly individual and marital therapy, leave from work for four months. Medication has included a combination of SSRI class of medication, stimulant ( Focalin, Ritalin LA, Metadate ) and Rivastigmine.