Neurology expert witness discusses ischemic stroke and emergency room treatment

A neurology expert witness for the defense opines on a case involving a woman who alleges that delayed EHS treatment made her stroke worse. Plaintiff from Arizona was fifty-two-years-old when she suffered a second stroke. She went to the emergency room (ER) of the defendant hospital complaining of a headache for a week. Her blood pressure was significantly elevated. Over the course of several hours, the plaintiff’s condition worsened. She developed right-side weakness, slurred speech and right facial droop. She alleges that none of the guidelines for treatment of acute ischemic stroke were followed by the hospital. No significant treatment was offered to the plaintiff during the 10 hours she was at the emergency room until she was transferred. She was not even given aspirin, even though the CT showed no hemorrhage.

Upon arrival at another hospital, she received anticoagulant treatment: Lovenox by injection, a low molecular weight heparin. Full dose heparin was later added in place of the Lovenox.

Because the plaintiff presented to the defendant emergency room when the symptoms were still just prolonged headache and significantly elevated blood pressure (and history of recent minor stroke), the only reasonable assumption, she argues, is that appropriate and timely care, would probably have resulted in a far better outcome.

Question(s) For Expert Witness

1. Was the appropriate treatment the administration of an anticoagulant?

2. Would the plaintiff have had a better outcome?

Expert Witness Response

In my experience both as a practicing neurologist and as a teaching professional, the plaintiff’s expectation that the appropriate mode of treatment in response to the plaintiff’s stroke was immediate anticoagulation with heparin and Lovenox, is not supported by the medical literature, and such treatment is not a professionally accepted or acceptable response to acute ischemic stroke, which the medical records reflect is the type of stroke suffered by the plaintiff.

Whatever the origin of the plaintiff’s acute ischemic stroke, at that time, as well as today, the scientific and medical literature reporting studies and trials uniformly state that treatment with anticoagulants is not the standard of care and is not recommended for acute ischemic stroke patients, including patients with cardioembolic stroke. Overall, early anticoagulation was not associated with improved functional status or lower mortality of ischemic stroke patients. In patients with acute ischemic embolic strokes of cardiac origin, anticoagulation within 30 hours of stroke onset was not associated with either improved functional outcome or lower mortality.

The expert is a neurologist and associate neurology professor. He has instructed about 1,500 residents and 2,000 medical students and evaluated and treated more than 200,000 patients.