Transient Ischemic Attack: Medical Malpractice Lawsuit Settlement is $2M
2015 Medical Malpractice Trial Report
Neurologist's delay in diagnosis and treatment of TIA results in stroke and permanent left side paresis in a 50-year-old man
Plaintiff presented to his primary care physician with complaints of left-hand numbness, decreased grip strength, increased blood pressure, and a family history of coronary artery disease. The PCP’s impression was that the symptoms were due to trauma or a neurologic etiology, and he referred Plaintiff to a hand surgeon for further evaluation. After a negative exam by the hand specialist he was referred to a neurologist.
Defendant neurologist examined the plaintiff on 11/9/05. He performed an EMG and concluded that the negative study did not explain the plaintiff’s symptoms. He ordered a MRI of the cervical spine which was also non-diagnostic.
On 12/7/05, defendant neurologist met with plaintiff again. Despite his hypertension, family history, unexplained left hand and arm numbness, and parasthesis, the defendant did not order any further work-up or testing. Instead, he recommended follow-up in three months. He did not communicate with the PCP about test results, plan or a differential diagnosis. At this point an evaluation of the carotids was required as well as a MRI of the brain to rule out a central lesion.
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On 1/11/06, PCP saw plaintiff again and noted that his blood pressure and cholesterol remained elevated. Despite the negative EMG and MRI, no further workup or testing in the form of MRA or MRI of the brain was ordered despite having a patient with continued unexplained symptoms.
Twenty days later, the plaintiff suffered an acute cerebral vascular accident. Upon arrival to the ER with slurred speech and leg weakness it was reported that the symptoms began 20-30 minutes earlier. Despite being within the 3 hour window for TPA and a CT scan negative for a bleed, the neurologist advised against TPA. Deficits worsened and plaintiff was transferred to a tertiary care center where he received medication for an embolic stroke secondary to critical stenosis of the right ICA. He was discharged to a rehabilitation facility, where he remained for a month before undergoing carotid endarterectomy. The plaintiff currently suffers significant, lasting neurological impairment.
The PCP testified that the testing did not explain the plaintiff’s symptoms, but he believed he was still under the care of the neurologist. He was not aware of the EMG findings and had he known about the negative EMG he would have ordered further testing. The neurologist testified his office evaluations were appropriate and the decision not to give TPA was based on uncertainty on the timing of onset of symptoms.
The case went to mediation in the weeks prior to trial and settled for $2,000,000.
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