Patient: Mr. BP, Male, Age 23
Mr. BP was evaluated by Dr. Sandlin Lowe at the Amen Clinic 07/31/2020 and was referred to Connecticut Spine and Health Center for evaluation and treatment of Cranio-cervical Syndrome.
Current Diagnosis:
- Unspecified Mood (affective) disorder
- Anxiety disorder, unspecified
- Post-traumatic stress disorder, unspecified
- Attention-deficit hyperactivity disorder, other type
- Personal history of traumatic brain injury
- Obsessive-compulsive behavior
Chief Complaints on Initial Visit 08/12/2020:
- Constant neck pain
- Neck stiffness
- Pain across shoulders
- Mid back stiffness
- Brain fog
- Occasional headaches
- Poor concentration
- Difficulty processing information when reading
- Mood swings
- Anxiety
- Difficulty concentrating
- Obsessive compulsive disorder
- Irritability
History:
The patient has history of brain, head and neck trauma.
Exam:
Orthopedic, neurologic, cervical range of motion and palpation examination along with Atlas Orthogonal radiographic imaging and analysis.
Diagnosis:
- Cranio-cervical syndrome
- Segmental and Somatic dysfunction of the cervical spine
Treatment:
Atlas Orthogonal treatment from the 22nd of September, 2020.
Current status:
Patient is under ongoing wellness care.
Outcome:
Mr. BP reported:
- Improved mood
- Decrease in anxiety
- Decreased depression
- Improved mental clarity
- Decreased brain fog
- Improved Concentration
- Improved reading comprehension
- Absence of headaches
- Decrease in neck pain and neck stiffness