STROKE MEDICAL NEGLIGENCE DELAYED DIAGNOSIS OF STROKE

John Whelan Solicitor with specialist expertise in Stroke Medical Negligence gives an example of a case where there was a delayed diagnosis of stroke.       

A case of delayed diagnosis of stroke can occur when symptoms are misinterpreted or the appropriate diagnostic tests are not performed in a timely manner.

Case Example: Delayed Diagnosis of Stroke

Patient presents to the A&E complaining of dizziness, nausea, and mild difficulty speaking. The Patient also mentions feeling off balance while walking. These symptoms started a few hours earlier but the Patient thought it might be due to stress or dehydration.

Initial A&E Assessment:

1. Vital signs: Normal, except for slightly elevated blood pressure (150/90 mm Hg).
2. Physical examination: The Patient appears alert, oriented, and can move all limbs. No significant weakness is noted. The Patient’s speech is slightly slurred, but no facial droop is present.
3. Initial diagnosis: Benign causes are considered first, such as dehydration or inner ear issues like vertigo. The attending physician suspects a case of labyrinthitis or inner ear inflammation and prescribes an anti nausea medication.
4. No imaging is ordered initially since the Patient’s symptoms are mild and non specific.

Progression of Symptoms:

Over the next 24 hours, the Patient’s symptoms worsen.   The Patient’s balance deteriorates, and the Patient develops significant right sided weakness, making it difficult to walk.    The Patient’s family becomes concerned and returns the Patient to the A&E. 

Reevaluation:

At this point, the attending physician considers a stroke more seriously and orders a CT scan, which reveals a brainstem infarct (ischemic stroke in the brainstem region).

Outcome:

Due to the delay in diagnosis, the Patient did not receive timely thrombolytic therapy which is most effective when given within certain hours of symptom onset.    The Patient’s recovery is complicated, and the Patient experiences long term physical deficits, including partial paralysis and difficulty speaking.

Important Points of the Case:

1. Atypical Presentation: The Patient’s symptoms were subtle and initially attributed to a benign cause (vertigo), which can mimic stroke.
2. Lack of Imaging: No immediate brain imaging was performed during the initial A&E visit, which delayed the stroke diagnosis.
3. Window for Treatment: Because of the delay, the Patient missed the opportunity to receive clot dissolving medication or mechanical thrombectomy, which could have significantly improved the Patient’s outcome.

For more detailed insights into how Stroke Medical Negligence and Patient Safety impacts you and how Whelan Law can support you, please visit our Patient Safety Rights Legal Advice https://www.whelanlaw.ie/news/stroke-medical-negligence-claims-what-you-need-to-know/