Traumatic brain injury (TBI) is associated with a variety of cognitive and behavioural disorders. A few reports have suggested that pharmacotherapy might be useful in the management of these disorders. We present a case of a patient who suffered a left subdural hematoma and herniated. Several months after the injury, his function was severely limited. Nevertheless, he demonstrated a clear improvement in response to oral methylphenidate and parenteral physostigmine. We conclude that specific pharmacotherapy may result in major cognitive and functional improvements in severely impaired patients.