a.
40 year old ambidextrous female involved
in a high speed motor vehicle accident as she was struck from behind
by a drunk driver. She reported a brief episode of confusion following
the accident and was treated for a wrist fracture that evening after a
visit to the emergency room.
b. Studies of the brain were not remarkable to report
before the SPECT study. Neuropsychological testing revealed superior
general memory function for visual and immediate auditory testing by
low average range after a long delay on word list recall. She endorsed
severe symptoms of depression and anxiety.
c.
Clinical problems initially included
neck and back pain, mood liability with crying without obvious
triggers, and lack of attention.
d. Litigation is pending.
e.
SPECT imaging revealed a focal decrease
in activity in the left prefrontal area noted more prominently in the
activation study. Also, a focal increase in the Thalamus in this study
and the right Caudate and Insula in the baseline study was seen.
Treatment initially
included physical therapy and chiropractic along with SSRI medication.
This medication was felt to produce emotional indifference and was
discontinued. A stimulant was added with a clinical report of improved
concentration despite the neuropsychological testing. A short term
trial with Galantamine and Rivastigmine was tired. An ongoing report
of anxiety was then treated with SNRI medication with improvement and
no emotional indifference symptoms
