Family Physician Delays the Diagnosis of Brain Cancer

This case involved a forty five-year-old male who had significant, long-standing headaches consistent with a malignant brain tumor. The man visited his primary care doctor because of constant dull headaches he experienced. He had a positive family history of migraine headaches both in his father and brother. The family physician initiated him on a non-steroidal anti-inflammatory (NSAID) and scheduled him for a follow-up in two weeks. Upon follow-up, the patient expressed that he still experienced headaches which increased in severity since the last visit. Due to his family history, the doctor tried a trial of sumatriptan, under the suspicion that he was having migraine headaches. A follow-up appointment was never officially scheduled. Over the next month, the man stopped taking sumatriptan due to side effects and lack of efficacy. One day at home, the patient began to convulse, which caused him to drop to the floor. He was brought to the emergency department, where he was diagnosed with a brain tumor on an MRI. Biopsy of the tumor and further evaluation revealed a stage 3 glioblastoma, with metastases to the regional lymph nodes and right lung. He was then scheduled for stereotactic brain surgery, followed by chemotherapy. Nine months later, the patient stopped responding to treatment and died shortly thereafter.

Question(s) For Expert Witness

1. Did this physician follow the proper standard of care, and what could have been done to better treat this patient’s complaints?

Expert Witness Response

This physician did not properly follow up with a patient with headaches not responding to medication. Secondary causes of headaches could be very fatal to a patient’s health, for example, a brain tumor. In this case, the physician should have ordered some imaging study of the brain to rule-out malignancy. MRI is most commonly used to diagnose brain tumors. Earlier imaging in this patient could have lead to the proper diagnosis and subsequent treatment. Brain cancer can present with headaches, nausea, vomiting, seizures, syncope, cognitive dysfunction, weakness, sensory loss, aphasia, and visual spatial dysfunction. Glioblastoma is the most common primary brain tumor that is usually found in the cerebral hemispheres. Although aggressive, an earlier diagnosis could have improved the longevity and quality of life in the patient.