Even with public education campaigns and the introduction of primary and comprehensive stroke centers in hospitals, there are still around 165,000 strokes per year that are misdiagnosed annually in United States emergency rooms.
We’re all familiar with the medical condition called stroke, but did you know that there are several different cerebrovascular disorders that fall under the stroke umbrella?
Ischemic strokes
According to the American Stroke Association, ischemic strokes account for 87% of all strokes. The remaining strokes are hemorrhagic strokes, caused by bleeds.
Ischemic strokes develop when a blood clot interrupts blood flow to the brain, creating ischemia by disrupting oxygen and nutrients.
Anterior circulation strokes
Not all ischemic strokes are alike. They’re classified depending on the part of the brain’s vascular circulation that’s affected by the clot blocking blood flow.
Most ischemic strokes involve the anterior (front of the body) circulation to the brain. Anterior circulation ischemic strokes typically cause symptoms that we’ve all heard a lot about, sometimes abbreviated as “FASTâ€:
• F = Facial droop on one side
• A = Arm weakness on one side
• S = Speech difficulty (aphasia)
• T = Time to call 911
Posterior circulation strokes
Posterior circulation ischemic strokes involve the posterior (back of the body) circulation to the brain. They account for around 20% of ischemic strokes, or around 160,000 cases per year in the United States.
Perhaps because posterior circulation ischemic strokes have different symptoms, they’re three times more likely to be misdiagnosed.
The New England Medical Center Posterior Circulation Registry identified the most common presenting signs and symptoms of a posterior circulation ischemic stroke:
• Dizziness or vertigo (feeling off balance)
• Arm or leg weakness or loss of muscle control (ataxia) on one side
• Gait ataxia (imbalance or poor coordination when walking)
• Difficulty speaking (dysarthria)
• Abnormal eye movements (nystagmus)
• Headache
• Nausea and vomiting
When a patient presents to the emergency room with the symptoms, the standard of care requires an emergency physician or provider to rule out a central process before settling on a benign diagnosis, such as a migraine headache or vertigo, and discharging the patient home. According to a board-certified emergency physician expert we retained to review a posterior circulation stroke case, one investigative tool is to assess and document whether the patient is able to stand and walk unassisted and independently.
Other diagnostic tools that are available include ordering an MR angiogram to determine if there’s a problem in the posterior vasculature and consulting with a neurologist before discharging the patient.
Treating ischemic strokes
When encountering symptoms that are consistent with stroke, it’s up to the patient to get to a hospital emergency room as soon as possible. Some neurologists explain the urgency as “time is brain.†That’s because there’s a limited treatment window.
Once a patient gets to an emergency room, though, it’s up to the triage nurse to recognize a potential stroke and get urgent medical attention, leading to activation of the stroke protocol or team.
Typically, an emergency physician will order a CT scan of the brain as part of a stroke workup. If the scan is returned as negative, that doesn’t mean that the patient isn’t having an ischemic stroke. Rather, a negative CT means that there’s not a brain bleed that would prevent administration of the clot-busting drug tPA.
If a physician concludes that the patient is likely experiencing ischemic stroke and the patient is within a 3–4.5 hour treatment window, then the standard of care normally requires administering tPA to break up the blood clot. This should restore normal blood flow to the brain and may reverse stroke signs and symptoms.
Unfortunately, we’ve handled numerous cases where emergency room nursing staff, physicians, and even consulting neurologists have bungled the diagnostic process, making errors that pushed the patient outside the tPA treatment window. By the time the stroke was diagnosed, it was too late. That’s medical negligence.
If you’ve been seriously injured in Texas because of poor stroke care, then contact a top-rated, experienced Texas medical malpractice lawyer for free consultation about your potential case.
