Delay in Treatment Causes Patient to Suffer Hemorrhagic Stroke

This case involves a 50-year-old man with high blood pressure who presented to the hospital with upper abdominal pain. The patient was not seen immediately and within the next hour he suffered a hemorrhagic stroke. An MRI revealed acute infarcts in the insular cortex of the right cerebral hemisphere, and the right parietal lobe. There was also diminished flow in the posterior cerebral artery and a concern about vasculitis was raised.

Question(s) For Expert Witness

1. How often do you treat patients with hypotensive "watershed" infarcts?

2. How often do you treat patients with cerebral vasculitis, including Lupus vasculitis?

3. Are there specific diagnostic criteria that can differentiate between these two conditions?

4. Have you ever reviewed a similar case? If yes, please elaborate.

Expert Witness Response E-004796

I have over 30 years of experience in academic vascular neurology research, clinical experience and teaching. I have served on guideline committees for the American Heart Association/American Stroke Association, AAN and NSA. I have conducted clinical trials and NIH-funded epidemiology research for over 25 years. I see patients with hypotensive "watershed" ischemia several times a year and also see cerebral Lupus vasculitis once every couple of years. I am familiar with the diagnostic criteria used to differentiate between these 2 conditions. I have reviewed cases of both watershed hypotensive stroke and lupus stroke in the past.