What you should know about abnormal neurological signs

As a Houston, Texas medical malpractice lawyer, I handle a lot of cases where patients were seriously injured because a physician or nurse did not recognize neurologic changes.

Neurologists and other medical experts recognize that even subtle neurologic changes can be early indicators of a serious medical condition that needs promptly addressed.

Neurologic changes include things like altered mental status (someone acting differently than normal) and inability to move the eyes or extremities normally. Physicians are trained to provide head-to-toe neurologic examinations of the complete nervous system. For hospitalized patients, doctors often order the registered nurses to perform periodic neuro checks every four, eight, or 12 hours, depending on the circumstances.

Neuro checks are one of the most important functions of registered nurses. A doctor may see a patient once a day, but the nursing staff is there constantly. Doctors rely on nurses to monitor their patients, including performing neuro checks, as ordered, and then to communicate any abnormal findings to them. In the healthcare industry, nurses are often referred to as the eyes and ears of physicians. After all, doctors cannot treat what they do not know.

In my experience from handling medical negligence lawsuits, problems with neurologic examinations or checks frequently come up in two ways.

First, nurses either do not follow physician orders regarding neuro checks or fail to inform doctors of their findings in a timely manner.

I am working on a case right now involving a patient who was hospitalized following a back surgery. The nurses noted that his lower extremities were numb and his foot reflexes were weak. They also found that he was abnormally retaining urine. All of these are signs of a potential hematoma cutting off blood supply to spinal cord, but the nurses waited over eight hours to tell a doctor. In the same case, although the surgeon had ordered neuro checks every eight hours, there was a 12-hour period where nurses made no assessments at all.

The second area of concern is inadequate physician neurologic examinations.

A neurologist wrote an interesting opinion piece that was published in November 2017 in the Journal of the American Medical Association (JAMA) Network. He commented that, “There is no doubt that the art of the neurologic examination is already being lost, as some [technological] advances come to supplant rather than complement the clinical examination.”

I agree that this is a big part of the problem. With the advent of advanced radiology imaging, like CT and MRI scans, and a variety of lab studies, some doctors have become more reliant on tests than actually eyeballing and assessing the patient in front of them.

I cannot even guess how many times clients and family members have shared their frustration that their doctors barely looked at them, but rather spend their time looking at computer screens with test results. This type of practice leaves of significant amount of information unknown and increases patient risk.

This is evidenced by what I call chart creep, when it comes to hospital-based care. A patient comes in the hospital and speaks to a triage nurse about why he or she came to the hospital. The triage nurse writes a note in the electronic medical record. Once the patient gets to a bed, a new nurse reads the triage nurse report, quite often copying and pasting what was written, rather than doing a thorough interview or history of the patient in front of them. Guess what happens next? When the physician sees the patient, the traditional history is skipped, and the history or documentation from the prior nurses is cut and paste it with the click of a mouse or keyboard.

The risk to the patient comes about when anyone along the way misunderstands something or makes a mistake. This happens in busy hospitals. I have seen thin female patients of one race described as obese males of a different race in medical records. Even more concerning, I have seen an unsubstantiated opinion by an EMT—like that a patient’s abnormal neurologic status is because of drinking or drug use—corrupt the thinking of the triage nurse, which is copied and pasted down the line, leading to a quick discharge of the patient from the hospital.

What you can do

As a patient, of course, you are totally reliant on the healthcare providers to perform a proper neurologic assessment. You cannot do it yourself. There are a few things, though, that you can do to improve patient safety.

First, keep in mind the risk of chart creep. Give a polite, thorough, and accurate explanation of what brought you to the doctor’s office or hospital to the first nurse who sees you. I believe that some people are tempted to attempt to abbreviate this encounter, just to get to the doctor, but that would be a mistake. The nurse’s assessment and notes help to inform the doctor’s impression of you as a patient, as well as what assessment and treatment may be necessary.

Second, when seen by a physician, repeat your explanation of what brought you to the office or hospital. It is important to be complete and thorough, sharing when your problems or symptoms began, and anything else they find relevant. Ask polite questions to ensure that you are being recognized as an individual patient, rather than a name occupying a field on a computer screen.

We are here to help

If you or a family member has been seriously injured as a result of inattentiveness, medical mistake, or medical malpractice, call Painter Law Firm, at 281-580-8800, for a free consultation about your potential case.


Robert Painter is a medical malpractice and wrongful death attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who files lawsuits on behalf of patients and family members against hospitals, doctors, surgeons, anesthesiologists, and other healthcare providers.

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.