A traumatic car crash

Abstract

A healthy 47-year-old man sustained head and multiple skeletal injuries in a motor vehicle accident in January, 1998. The patient’s car was struck three times. In the emergency room, the patient was treated for lumbar, rib, and sternum fractures. Neurological examination was normal. The patient did not recall losing consciousness and had no complaints of double or blurred vision. 2 months after the accident, the patient and his family noticed severe cognitive impairment characterised by his inability to process simple information. He complained of severe headaches and decreased peripheral vision. He was examined neurologically 8 months after the accident. A positron emission tomography (PET) scan showed right versus left cortical asymmetry with large areas of hypometabolism in the right frontal lobe (figure). In a neuropsychological examination, the patient scored in the borderline or extremely low range in all of nine psychological tests. These included the Derogatis Symptom Checklist, Grooved Pegboard Test; Trail Making Tests A & B, Digit Vigilance Test, Ammons Quick Test, Hooper Visual Organization Test, Wechsler Memory Scale-III (partial), Wechsler Adult Intelligence Scale-III, and the Wide Range Achievement Test-Rev. Post-traumatic dementia was diagnosed.