Patient Suffers Undiagnosed Stroke After Car Accident

This case involves a male patient in Tennessee who was previously in excellent health who was involved in a car accident. The patient began to feel neck muscle stiffness, headaches and shoulder pain days after the incident occurred. The patient presented to his primary care doctor, who diagnosed him with muscle spasms. A week later, the patient presented to the emergency room with complaints of right-sided weakness, vomiting, headache, and sensitivity to light. Doctors undertook some lab testing, but did not immediately order an MRI of the patient’s brain. The patient was given pain and nausea medication, however his condition continued to deteriorate. An MRI later revealed the presence of a hemorrhagic stroke, and the patient went on to suffer from permanent brain damage.

Question(s) For Expert Witness

1. Do you routinely treat patients similar to the one described in the case?

2. Have you ever had a patient develop the outcome described in the case?

3. Do you believe there may have been a deviation in the standard of care that contributed to this patient's poor outcome?

Expert Witness Response E-005875

I frequently treat patients presenting after motor vehicle collision. Vertebral artery dissection is very rare, but I have seen it several times. Based on what I have read here, I don't see explicit evidence of a deviation in the emergency department standard of care, although a deviation could become clear with more information. However, it is not clear from the case whether there was a neurological deficit on initial examination that would have prompted advanced imaging or if there was an adverse outcome that delayed anticoagulation. I am a board-certified emergency physician spending the majority of my professional time teaching and practicing emergency medicine.