Texas ER botches diagnosis of man's posterior circulation stroke

A man in his 40s suddenly felt very dizzy and became nauseated and vomited. Let’s call him John. John’s wife called 911 within five minutes and reported that he was unresponsive at that time.

When the ambulance and emergency medical service (EMS) showed up at John’s house five minutes later, he was sitting upright at the dining room table. He was able to answer questions and described his chief complaint as dizziness and vomiting. He described the dizziness as “like the room was spinning.” He also told EMS that his right arm felt numb and very cold, his ears were ringing, and his eyes were sensitive to light.

EMS did a standard stroke assessment and documented that the results were negative. They noted his high blood pressure and felt it was contributing to his symptoms. EMS transferred him by ambulance to a nearby hospital emergency room (ER).

Posterior circulation ischemic stroke

About 87% of all strokes are ischemic strokes, where a clot blocks blood flow to the brain. Of ischemic strokes, a minority of 20–25% involve the posterior circulation, the vertebrobasilar arterial system in the back of the head. These are called posterior circulation strokes.

The posterior circulation blood vessels supply important brain structures including the brainstem, cerebellum, midbrain, thalamus, and parts of the temporal and occipital cortex. The signs and symptoms of this type of stroke differ from those that are commonly publicized:

• Vertigo or dizziness

• Nausea and vomiting

• Poor balance

• Limb weakness on one side

• Slurred speech

• Visual disturbance or double vision

• Headache

Misdiagnosis of posterior circulation ischemic stroke

In John’s case, the emergency physician documented that immediately before arriving, John had some facial asymmetry, nausea, vomiting, and a tremendous headache. At the time of the physician assessment, though, the symptoms were not present. Around the same time, a nurse documented neurologic symptoms including dizziness, nausea, and weakness.

When John got to the ER, it was clear that stroke was initially on the ER physician’s mind because he ordered a stat CT scan of the head under the stroke protocol. John was in the CT scanner within 10 minutes of arriving in the ER. That’s impressive!

The radiologist interpreted the CT scan as negative. Many people think that this is good news because it means no stroke is occurring. That’s not necessarily the case, though. It takes several hours before a stroke will appear on CT imaging. MRIs can detect them more quickly but take more time to perform. One of the values of CT scans for potential strokes is to determine whether there’s any evidence of brain bleeding, which would be a contraindication (would rule out) for using the clot-busting drug tPA for the patient, because it could cause more bleeding.

Thus, John’s CT didn’t rule out a stroke, but it did rule out that he wasn’t having a brain bleed at the time, which would’ve meant he couldn’t be given tPA to bust up the clot. After the negative CT scan came back, though, the ER doctor and team dropped the ball for hours upon hours.

Despite his classic posterior stroke signs and symptoms, the ER doctor didn’t consult a neurologist for nearly seven hours. When the neurologist saw John the next day, he noted in the medical records “it’s unclear why this patient wasn’t considered a tPA candidate.”

Unfortunately, John’s posterior circulation stroke was misdiagnosed. The medical literature reflects that this type of ischemic stroke is misdiagnosed twice as often as the more common strokes affecting the anterior circulation.

The delay in diagnosis and treatment led to serious permanent disabilities for John, including the inability to walk, impaired arm movement, and vision issues.

Proving a stroke medical negligence claim is challenging under existing law, so if you’ve been seriously injured because of stroke misdiagnosis in Texas, then contact a top-rated, experienced Texas medical malpractice attorney for a free consultation about 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.