a. 60 year old male restrained driver of a truck hit head on by
another vehicle. He sustained a brief concussion with subsequent
acute neck pain.
b. The brain MRI study was unremarkable, his cervical spine
showed a small C5-6 level disc herniation and stenosis. A sleep
study revealed a mixed central-peripheral pattern of obstruction.
Neuropsychological testing revealed impaired language function with
semantic fluency, constructional apraxia, average working memory,
difficulty with abstract reasoning, visual acuity and slowed visual
attention processing and severe depression.
c. Litigation is pending.
d. Clinical problems have included the following;
1. Somatic complaints of neck pain ( traumatic torticollis )
and excessive daytime fatigue.
2. Emotional complaints of depression, mood lability, change in
personality causing marital difficulties.
3. Cognitive complaints of memory loss, especially for names,
daily forgetfulness in planning and decrease in mental
e. SPECT Imaging showed the following changes in perfusion;
1. a pattern of global decrease in perfusion involving the
Frontal and Parietal lobes.
2. a very significant focal decrease in the right superior
3. a very significant focal increase in the left Caudate and
f. Treatment initially included physical therapy for neck pain
and Depakote for mood swings. After my assessment 18 months post
injury, Modafanil was added for daytime fatigue, Osteopathic
Manipulation and Prolotherapy was added for neck pain and ligament
injury pattern. CPAP was added for apnea along with Sodium Oxybate
for daytime tiredness. Depakote dose was lowered and Ariprprazole
was added for mood swings. Alprazolam was discontinued.