J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website https://jnr.elmerpub.com

Case Report

Volume 16, Number 4, December 2026, pages 270-281

Multimodal Neurological Assessment and Targeted Rehabilitation Following Motor Vehicle Collision-Induced Mild Traumatic Brain Injury: A Case Report

↓ Figure 1. Longitudinal trajectory of concussion symptom burden and functional activity level from initial post-injury assessment to final documented follow-up. The primary y-axis (left) displays total Concussion Symptom Checklist (CSC) scores (scale 0–132, with higher scores indicating greater symptom burden). The secondary y-axis (right) displays self-reported functional activity level as a percentage of pre-injury normal. Data points represent documented assessment dates: June 27, 2023, September 13, 2023, October 17, 2023, November 1, 2023, May 23, 2024, and April 2, 2026. Note: The July 31, 2023 data point is excluded from graphical representation due to a suspected data recording artifact in the source document, as noted in the manuscript text. The overall trajectory demonstrates gradual, non-linear reduction in symptom burden and progressive, though incomplete, recovery of functional activity level over the approximately 34-month follow-up period.

↓ **Table 1.** Clinical Timeline Documenting Key Events, Assessments, and Findings From the Date of Injury (June 14, 2023) Through the Most Recent Documented Follow-Up (April 2, 2026)
Date	Event/assessment	Key finding or outcome
Events are presented in chronological order. ADL: activities of daily living; ACE: Acute Concussion Evaluation; CSC: Concussion Symptom Checklist; DHI: Dizziness Handicap Inventory; DTI: diffusion tensor imaging; DUD: Functional Disability Assessment; EEG: electroencephalography; FA: fractional anisotropy; GAD-7: Generalized Anxiety Disorder-7; HIT-6: Headache Impact Test-6; HRV: heart rate variability; MMSE: Mini Mental State Examination; MRI: magnetic resonance imaging; PCL-5: PTSD Checklist for DSM-5; PHQ-9: Patient Health Questionnaire-9; PSS: Perceived Stress Scale; ROI: region of interest; SAC: Standardized Assessment of Concussion; SWI: susceptibility-weighted imaging; UPSIT: University of Pennsylvania Smell Identification Test.
June 14, 2023	Motor vehicle collision (rear-end impact by dump truck)	Immediate onset of headache, nausea, dizziness, visual disturbance, cognitive fog, light sensitivity
June 14, 2023	Emergency department evaluation (HCA Florida West End)	Cervical and thoracic X-rays, CT neck; no acute fracture or intracranial abnormality identified; no concussion diagnosis at ED
June 21, 2023	Initial chiropractic and clinical evaluation	Extensive cervical and lumbar examination findings; concussion symptom score 72; pain management assessment initiated
June 21, 2023	Work status documentation	Restricted duty/off work initiated
June 27, 2023	CSC	Total symptom score: 74; activity level 5% of normal
July 5, 2023	ACE symptom checklist; MMSE; CNS-LS; Epworth Sleepiness Scale	ACE total: 21 (all cognitive and emotional domains fully endorsed); MMSE 30/30; CNS-LS 17 (above PBA threshold)
July 12, 2023	C3Logix cognitive performance testing	Abnormal; symptom severity 76/162; SAC 19/30; simple reaction time 403 ms; Trail Making B 64.0 sec
July 19, 2023	HRV assessment	Low HRV; 111% arousal increase from baseline; elevated sympathetic response; impaired post-stress recovery
July 26, 2023	Quantitative pupillometry; RightEye oculometric assessment	Abnormal pupillometry (absent 75% recovery time); Saccades score 17; Pursuits score 40; EyeQ 39
July 31, 2023	Cervical and lumbar spine MRI	Cervical disc herniations C3-C4, C4-C5, C5-C6, C6-C7; straightening of cervical and lumbar lordosis; craniocervical ligaments normal
July 31, 2023	CSC	Total symptom score documented (data recording artifact noted; not clinically interpreted)
August 1, 2023	BrainCheck neurocognitive; WAVi EEG; BTrackS posturography; UPSIT olfactory; DHI; GAD-7; HIT-6; PCL-5; PHQ-9; PSS	BrainCheck combined 54/200 (first percentile); EEG P300 voltage 3.1 µV (markedly reduced); brain age equivalent 56 years; posturography bottom quartile (2/4 conditions); UPSIT 30/40 (moderate microsmia); DHI 62 (severe); HIT-6 70 (class IV); PCL-5 43 (above threshold); PHQ-9 11 (moderate); GAD-7 10 (moderate); PSS 31 (high)
September 13, 2023	CSC	Total symptom score: 80; activity level 40% of normal
September 15, 2023	Brain MRI with DTI and SWI	Abnormal DTI: 2/12 ROI and 2/6 white matter tracts with significantly decreased FA (> 95% probability axonal shearing injury); left internal capsule genu 10.3% lower than right; focal subcortical gliosis left parietal lobe
October 17, 2023	CSC; DUD	CSC total: 88; activity level 60% of normal; extensive functional limitations across work, home, exercise, and ADL domains
November 1, 2023	CSC; Pain Management Assessment	CSC total: 77; activity level 50% of normal; pain scores moderate to severe in cervical, thoracic, and lumbar regions
May 23, 2024	CSC; Pain Management Assessment; DUD	CSC total: 52; activity level 60% of normal
April 2, 2026	CSC; Pain Management Assessment	CSC total: 60; activity level 50% of normal; persistent symptoms including headache, dizziness, cognitive fog

↓ Table 1. Clinical Timeline Documenting Key Events, Assessments, and Findings From the Date of Injury (June 14, 2023) Through the Most Recent Documented Follow-Up (April 2, 2026)

Date

Event/assessment

Key finding or outcome

Events are presented in chronological order. ADL: activities of daily living; ACE: Acute Concussion Evaluation; CSC: Concussion Symptom Checklist; DHI: Dizziness Handicap Inventory; DTI: diffusion tensor imaging; DUD: Functional Disability Assessment; EEG: electroencephalography; FA: fractional anisotropy; GAD-7: Generalized Anxiety Disorder-7; HIT-6: Headache Impact Test-6; HRV: heart rate variability; MMSE: Mini Mental State Examination; MRI: magnetic resonance imaging; PCL-5: PTSD Checklist for DSM-5; PHQ-9: Patient Health Questionnaire-9; PSS: Perceived Stress Scale; ROI: region of interest; SAC: Standardized Assessment of Concussion; SWI: susceptibility-weighted imaging; UPSIT: University of Pennsylvania Smell Identification Test.

June 14, 2023

Motor vehicle collision (rear-end impact by dump truck)

Immediate onset of headache, nausea, dizziness, visual disturbance, cognitive fog, light sensitivity

June 14, 2023

Emergency department evaluation (HCA Florida West End)

Cervical and thoracic X-rays, CT neck; no acute fracture or intracranial abnormality identified; no concussion diagnosis at ED

June 21, 2023

Initial chiropractic and clinical evaluation

Extensive cervical and lumbar examination findings; concussion symptom score 72; pain management assessment initiated

June 21, 2023

Work status documentation

Restricted duty/off work initiated

June 27, 2023

CSC

Total symptom score: 74; activity level 5% of normal

July 5, 2023

ACE symptom checklist; MMSE; CNS-LS; Epworth Sleepiness Scale

ACE total: 21 (all cognitive and emotional domains fully endorsed); MMSE 30/30; CNS-LS 17 (above PBA threshold)

July 12, 2023

C3Logix cognitive performance testing

Abnormal; symptom severity 76/162; SAC 19/30; simple reaction time 403 ms; Trail Making B 64.0 sec

July 19, 2023

HRV assessment

Low HRV; 111% arousal increase from baseline; elevated sympathetic response; impaired post-stress recovery

July 26, 2023

Quantitative pupillometry; RightEye oculometric assessment

Abnormal pupillometry (absent 75% recovery time); Saccades score 17; Pursuits score 40; EyeQ 39

July 31, 2023

Cervical and lumbar spine MRI

Cervical disc herniations C3-C4, C4-C5, C5-C6, C6-C7; straightening of cervical and lumbar lordosis; craniocervical ligaments normal

July 31, 2023

CSC

Total symptom score documented (data recording artifact noted; not clinically interpreted)

August 1, 2023

BrainCheck neurocognitive; WAVi EEG; BTrackS posturography; UPSIT olfactory; DHI; GAD-7; HIT-6; PCL-5; PHQ-9; PSS

BrainCheck combined 54/200 (first percentile); EEG P300 voltage 3.1 µV (markedly reduced); brain age equivalent 56 years; posturography bottom quartile (2/4 conditions); UPSIT 30/40 (moderate microsmia); DHI 62 (severe); HIT-6 70 (class IV); PCL-5 43 (above threshold); PHQ-9 11 (moderate); GAD-7 10 (moderate); PSS 31 (high)

September 13, 2023

CSC

Total symptom score: 80; activity level 40% of normal

September 15, 2023

Brain MRI with DTI and SWI

Abnormal DTI: 2/12 ROI and 2/6 white matter tracts with significantly decreased FA (> 95% probability axonal shearing injury); left internal capsule genu 10.3% lower than right; focal subcortical gliosis left parietal lobe

October 17, 2023

CSC; DUD

CSC total: 88; activity level 60% of normal; extensive functional limitations across work, home, exercise, and ADL domains

November 1, 2023

CSC; Pain Management Assessment

CSC total: 77; activity level 50% of normal; pain scores moderate to severe in cervical, thoracic, and lumbar regions

May 23, 2024

CSC; Pain Management Assessment; DUD

CSC total: 52; activity level 60% of normal

April 2, 2026

CSC; Pain Management Assessment

CSC total: 60; activity level 50% of normal; persistent symptoms including headache, dizziness, cognitive fog

↓ **Table 2.** Summary of Multimodal Diagnostic Findings Organized by Assessment Domain
Assessment domain	Instrument/test	Key finding	Interpretation
Each row presents the assessment domain, the specific instrument or test used with date of administration, the key quantitative or qualitative finding, and the clinical interpretation. CNS-LS: Center for Neurologic Study-Lability Scale; DHI: Dizziness Handicap Inventory; DTI: diffusion tensor imaging; EEG: electroencephalography; FA: fractional anisotropy; GAD-7: Generalized Anxiety Disorder-7; HIT-6: Headache Impact Test-6; HRV: heart rate variability; mTBI: mild traumatic brain injury; PCL-5: PTSD Checklist for DSM-5; PHQ-9: Patient Health Questionnaire-9; PSS: Perceived Stress Scale; ROI: region of interest; SAC: Standardized Assessment of Concussion; SWI: susceptibility-weighted imaging; UPSIT: University of Pennsylvania Smell Identification Test.
Neurocognitive	C3Logix (July 12, 2023)	Symptom severity 76/162; SAC 19/30; reaction time 403 ms; Trail Making B 64.0 s	Abnormal; consistent with mTBI
Neurocognitive	BrainCheck (August 1, 2023)	Combined score 54/200 (first percentile); Trails A and B very low; memory very low	Cognitive impairment likely; consistent with mTBI
Neurophysiology	WAVi EEG (August 1, 2023)	P300 voltage 3.1 µV (reference 9–22 µV); Trail Making B 150 sec; brain age equivalent 56 years; frontal alpha asymmetry	Abnormal; consistent with mTBI
Oculomotor	RightEye (July 26, 2023)	Saccades 17; Pursuits 40; EyeQ 39	Impaired smooth pursuit and saccadic function
Vestibular/balance	BTrackS (August 1, 2023)	Standard condition 11th percentile; Vision condition 11th percentile; composite 156 cm	Moderately abnormal; central or vestibular/somatosensory dysfunction
Autonomic	HRV (July 19, 2023)	Low HRV; 111% arousal increase from baseline; impaired post-stress recovery	Autonomic dysregulation; sympathetic dominance
Pupillometry	Reflex Pro (July 26, 2023)	Absent 75% recovery time bilaterally; elevated left dilation speed	Abnormal; consistent with mTBI
Olfaction	UPSIT (August 1, 2023)	Score 30/40	Moderate microsmia (female norms)
Neuroimaging	Cervical MRI (July 31, 2023)	Disc herniations C3-C4, C4-C5, C5-C6, C6-C7; cervical lordosis straightening	Multilevel disc pathology; cervical spasm
Neuroimaging	Lumbar MRI (July 31, 2023)	Lumbar lordosis straightening; no disc protrusion	Straightening consistent with spasm; otherwise unremarkable
Neuroimaging	Brain MRI DTI/SWI (September 15, 2023)	2/12 ROI and 2/6 tracts with decreased FA (> 95% probability axonal shearing); left internal capsule genu 10.3% asymmetry; left parietal subcortical gliosis	Abnormal DTI consistent with traumatic axonal shearing injury
Patient-reported outcomes	DHI (August 1, 2023)	Score 62	Severe dizziness handicap
Patient-reported outcomes	HIT-6 (August 1, 2023)	Score 70	Class IV severe headache impact
Patient-reported outcomes	PCL-5 (August 1, 2023)	Score 43	Above clinical threshold for PTSD
Patient-reported outcomes	PHQ-9 (August 1, 2023)	Score 11	Moderate depression
Patient-reported outcomes	GAD-7 (August 1, 2023)	Score 10	Moderate anxiety
Patient-reported outcomes	PSS (August 1, 2023)	Score 31	High perceived stress
Patient-reported outcomes	CNS-LS (July 5, 2023)	Score 17	Above threshold for pseudobulbar affect

↓ Table 2. Summary of Multimodal Diagnostic Findings Organized by Assessment Domain

Assessment domain

Instrument/test

Key finding

Interpretation

Each row presents the assessment domain, the specific instrument or test used with date of administration, the key quantitative or qualitative finding, and the clinical interpretation. CNS-LS: Center for Neurologic Study-Lability Scale; DHI: Dizziness Handicap Inventory; DTI: diffusion tensor imaging; EEG: electroencephalography; FA: fractional anisotropy; GAD-7: Generalized Anxiety Disorder-7; HIT-6: Headache Impact Test-6; HRV: heart rate variability; mTBI: mild traumatic brain injury; PCL-5: PTSD Checklist for DSM-5; PHQ-9: Patient Health Questionnaire-9; PSS: Perceived Stress Scale; ROI: region of interest; SAC: Standardized Assessment of Concussion; SWI: susceptibility-weighted imaging; UPSIT: University of Pennsylvania Smell Identification Test.

Neurocognitive

C3Logix (July 12, 2023)

Symptom severity 76/162; SAC 19/30; reaction time 403 ms; Trail Making B 64.0 s

Abnormal; consistent with mTBI

Neurocognitive

BrainCheck (August 1, 2023)

Combined score 54/200 (first percentile); Trails A and B very low; memory very low

Cognitive impairment likely; consistent with mTBI

Neurophysiology

WAVi EEG (August 1, 2023)

P300 voltage 3.1 µV (reference 9–22 µV); Trail Making B 150 sec; brain age equivalent 56 years; frontal alpha asymmetry

Abnormal; consistent with mTBI

Oculomotor

RightEye (July 26, 2023)

Saccades 17; Pursuits 40; EyeQ 39

Impaired smooth pursuit and saccadic function

Vestibular/balance

BTrackS (August 1, 2023)

Standard condition 11th percentile; Vision condition 11th percentile; composite 156 cm

Moderately abnormal; central or vestibular/somatosensory dysfunction

Autonomic

HRV (July 19, 2023)

Low HRV; 111% arousal increase from baseline; impaired post-stress recovery

Autonomic dysregulation; sympathetic dominance

Pupillometry

Reflex Pro (July 26, 2023)

Absent 75% recovery time bilaterally; elevated left dilation speed

Abnormal; consistent with mTBI

Olfaction

UPSIT (August 1, 2023)

Score 30/40

Moderate microsmia (female norms)

Neuroimaging

Cervical MRI (July 31, 2023)

Disc herniations C3-C4, C4-C5, C5-C6, C6-C7; cervical lordosis straightening

Multilevel disc pathology; cervical spasm

Neuroimaging

Lumbar MRI (July 31, 2023)

Lumbar lordosis straightening; no disc protrusion

Straightening consistent with spasm; otherwise unremarkable

Neuroimaging

Brain MRI DTI/SWI (September 15, 2023)

2/12 ROI and 2/6 tracts with decreased FA (> 95% probability axonal shearing); left internal capsule genu 10.3% asymmetry; left parietal subcortical gliosis

Abnormal DTI consistent with traumatic axonal shearing injury

Patient-reported outcomes

DHI (August 1, 2023)

Score 62

Severe dizziness handicap

Patient-reported outcomes

HIT-6 (August 1, 2023)

Score 70

Class IV severe headache impact

Patient-reported outcomes

PCL-5 (August 1, 2023)

Score 43

Above clinical threshold for PTSD

Patient-reported outcomes

PHQ-9 (August 1, 2023)

Score 11

Moderate depression

Patient-reported outcomes

GAD-7 (August 1, 2023)

Score 10

Moderate anxiety

Patient-reported outcomes

PSS (August 1, 2023)

Score 31

High perceived stress

Patient-reported outcomes

CNS-LS (July 5, 2023)

Score 17

Above threshold for pseudobulbar affect