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 flexibility.

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 Frontal lobe.

3. a very significant focal increase in the left Caudate and Thalamus.

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.