a. 50 year old male executive restrained driver of a sports car hit from behind at a speed in excess of 50mph. He sustained bleeding to the left Parietal lobe and was hospitalized for several days. His initial Glascow Coma Scale was very low ; 6.
 

b. He underwent an emergency CT brain scan and subsequent brain MRI. Both studies showed a focal left Parietal bleed. A cervical MRI demonstrated moderate osteoarthritis, a sleep study demonstrated severe obstructive sleep apnea. Neuropsychological testing average IQ with slow processing speed on visual and verbal tasks.
 

 c. Clinical problems have included the following areas;

        1. initially headaches and neck pain , hip and back pain. Headaches have persisted over the past few years.

        2. cognitive reports of decreased mental stamina needed to perform his job, read and write at the same level of proficiency.

        3. emotional reports that included panic like feelings when driving and seeing a similar vehicle to the one in the accident, ongoing frustration with his job.
 

d. Treatment has included management of sleep apnea with CPAP, physical therapy exercise program, ongoing Osteopathic and Chiropractic manipulation of neck and spine including Cranial-Sacral treatment of headaches and ongoing individual psychotherapy. Cognitive rehabilitation was continued for two years.
 

 e. Litigation has been filed. He retired from work on a disability status.
 

 f. SPECT imaging studies demonstrated the following changes in perfusion;

        1. In the concentration study; very significant decrease in focal perfusion in the right superior Parietal lobe and left superior - lateral Parietal lobe, bilateral significant focal increase in the Caudate and left Thalamus.

        2. In the resting study; a decrease in the vertex region ( bilateral superior Parietal lobes ), very significant focal increase in the right Caudate.
 

g. Medication treatment has included SSRi class of medication for anxiety, stimulant medication and Rivastigmine for concentration and mental stamina. Headaches continue to be treated periodically with Fiorinal.