a. 40 year old right handed white male sustained a brain injury secondary to an explosion ten years earlier.

b. His initial treatment course included hospitalization with neurosurgery to remove the injured portion of the right Frontal-Temporal lobe. He underwent facial reconstruction surgery including an ocular prosthesis implant. He developed post traumatic epilepsy

c. Testing has included an abnormal brain MRI with atrophy of the right Frontal lobe, EEG studies show sharp waves in the region of injury, neuropsychological testing demonstrated multiple deficits with set shifting, cognitive flexibility, working memory.

d. Clinical problems have included;

1. chronic head and face pain partially responsive to daily narcotic medication.

2. Emotional complaints of change in personality with increased irritability, inappropriate humor, impulsivity.

3. A change in " sense of self ' experience with inability to grow and move forward in his personal development described as " lost in time "

e Litigation resulted in a permanent disability settlement.

f. SPECT Imaging was effected in part, by chronic narcotic dependence causing global hypoperfusion.

1. The resting study demonstrates absent perfusion in the right Frontal pole, inferior Frontal cortex extending to the anterior Temporal pole. There is global hypoperfusion of both hemispheres.

g. Treatment has included chronic pain management with narcotic medication. Other medication has included Dilantin for epilepsy, antipsychotic medication to reduce social impulsivity.