Misdiagnosis of Brain Hemorrhage Leads to Extensive Hospitalization

This case takes place in Minnesota and involves a 70-year-old patient who presented to the ER with dizziness and instability, after a period of exercise. She underwent an MRI and nothing showed up except some inflammation in the sinuses. The patient was diagnosed with a sinus infection and was started on treatment. She was admitted for monitoring. Approximately twelve hours later the patient’s condition had deteriorated such that a second MRI was performed which identified a diffuse subarachnoid hemorrhage. The patient underwent surgery to relieve the pressure. She was discharged home after five weeks in hospital and a rehab unit.

Question(s) For Expert Witness

1. How often do you treat patients with these presenting complaints?

2. What is the standard work up for these patients?

Expert Witness Response E-007492

When I am covering the ER, we see a patient with new onset dizziness and ataxia about once per week. The work up typically involves a neurological examination with special maneuvers to evaluate for vestibular (inner ear) dysfunction as a cause of the symptoms. If the patient has stroke risk factors and cannot be definitively diagnosed with vestibular dysfunction, we get an MRI and, depending on the prior probability for stroke and the degree of ataxia, we might admit the patient for a complete stroke work up and/or PT assessment. If symptoms persist and/or new neurological symptoms develop, it is likely that imaging would be repeated. If the patient's symptoms were advancing (new problems, not just worsening dizziness), we would likely obtain a CT angiogram to assess for posterior circulation stroke.