Myth buster: A negative CT scan doesn't necessarily mean that you're not having a stroke

There are two types of stroke, ischemic and hemorrhagic. In this article, we’ll focus on ischemic strokes.

Ischemic strokes

Ischemic strokes are by far and away the more common type, accounting for around 87% of all strokes. They’re caused when a clot blocks a blood vessel, either diminishing or cutting off blood supply to an area of the brain.

Ischemic strokes can be treated with the intravenous (IV) clot-busting drug called tissue plasminogen activator (tPA) within a window of 3 to 4.5 hours. Stroke and medical experts use tPA when indicated because it dissolves the blood clot and restores blood flow to the brain.

The signs and symptoms of ischemic stroke are well-known, following the acronym FAST:

F for facial droop on one side

A for arm weakness on the same side

S for speech difficulty, or aphasia

T for time to call 911 for emergency help

I like the FAST jingle because it reminds patients that when the signs are present it’s time to get to a hospital emergency room (ER) as soon as possible—even better, a hospital that is certified as a primary or comprehensive stroke center.

The misleading negative CT scan

One of the first things that a physician will likely do when evaluating an ER patient with ischemic stroke symptoms is order a stat CT scan of the brain. Stat means as soon as possible, because there certainly is an urgent need to get the results back quickly.

We receive a lot of calls from patients who timely presented to the ER but were misdiagnosed as not having a stroke and discharged after a CT scan came back as negative. Many patients and family members believe that a negative CT scan means that there is not a stroke. That’s certainly understandable because that’s what it sounds like when a doctor says it. The only problem is it simply is not true.

The reason that doctors order a brain CT scan for patients with ischemic stroke symptoms is to rule out the possibility of bleeding in the brain. The reason for this is it’s a contraindication—meaning it should never be done—for a physician to administer tPA to a patient with brain bleeding.

Thus, when a doctor tells a patient and family in an ER for ischemic stroke symptoms that the CT scan was negative, it simply means that the patient doesn’t have bleeding in the brain. It gives no information whatsoever about whether the patient is actually having a stroke. That’s because CT scanning technology won’t pick up the signs of an ischemic stroke for the first few hours after the onset of stroke symptoms. To get that level of immediate detail would require an MRI scan.

If you or a loved one is in the hospital ER with ischemic stroke symptoms and a doctor, physician assistant (PA), or nurse practitioner (NP) wants to push you out the door because of a negative CT scan, it’s time to push back.

Ask for a second opinion. This is particularly true if the news is being delivered by a resident or fellow physician who is still in training, or a mid-level provider (PA or NP).

Repeat the story of what happened. Share how the symptoms have not improved. Ask them to document that you still believe that you are having a stroke.

Demand to be seen and evaluated by an attending neurologist (the fully trained doctor who’s responsible for the care). Just going this far will likely get an attending neurologist to show up to do an in-person assessment. If needed, though, ask to see the charge nurse or nursing supervisor, and then repeat the whole story and sequence of events. Registered nurses must use the nursing process to form nursing diagnoses and have an independent duty of advocacy for their patients. That means, when warranted, they are required to go up the chain of command to get patients the medical care that they need.

Legal issues in ischemic stroke treatment

The time window for treating ischemic strokes is narrow. If a doctor and the hospital staff make the wrong decision and discharges a patient who’s actively having a stroke, there’s no chance to get that time back. By the time the patient returned for care, the tPA treatment window will be closed. Here at Painter Law Firm, in the past few years we’ve handled cases for patients seen and discharged from major Texas hospital ERs with active ischemic stroke symptoms. Those patients went a day or two later to get evaluated by a different facility and were correctly diagnosed as having had a stroke when they originally presented to an ER. How tragic!

The legal requirements for proving an ischemic stroke case are even narrower than the tPA treatment window, though. Because of a convoluted line of case opinions written by judges who don’t understand science, medicine, or statistics, it’s unlikely that a medical malpractice case could be proven if it took a patient much longer than one hour to arrive at the hospital emergency room from the onset of symptoms.

If you’ve been seriously injured because of stroke misdiagnosis and poor treatment in Texas, then contact an experienced, top-rated Houston, Texas medical malpractice lawyer to discuss your potential case.

Robert Painter
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Robert Painter

Robert Painter is an award-winning medical malpractice attorney at Painter Law Firm Medical Malpractice Attorneys in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits all over Texas. Contact him for a free consultation and strategy session by calling 281-580-8800 or emailing him right now.