Objective:To study mild head injury patients with poor psychosocial and vocational outcomes using neurological single photon emission computed tomography (neuroSPECT) imaging.Design:Case‐comparison study.Setting:VA Medical Center, outpatient clinics.Patients:Fourteen mild head injury patients with normal computed tomography (CT) and/or magnetic resonance imaging (MRI) scans and five normal controls. Head‐injured patients were selected because they had obtained and maintained highly responsible employment prior to injury, but were unable to sustain any occupation despite multiple attempts over a number of years after injury.Intervention:NeuroSPECT with technetium Tc 99m hexamethylpropyleneamine oxime.Main Outcome Measure:Regional abnormalities in cerebral perfusion as indicated by neuroSPECT.Results:This carefully preselected population consistently showed anterior mesial temporal hypoperfusion. By contrast, posterior temporal abnormalities were very infrequent. NeuroSPECT findings with regard to orbitofrontal damage were not as striking, but were statistically significant on the left and were sufficient to raise the question of dysfunction in this area as well.Conclusions:Findings indicate that some “mild” head injuries with unusually catastrophic psychosocial consequences can produce regional abnormalities in cerebral perfusion that are apparent with neuroSPECT, even in the absence of abnormalities seen on CT or MRI.