Stroke Missed by Primary Care Physician After Automotive Accident

This case involves a fifty-three-year-old obese male traffic police officer with a history of hypertension. While walking adjacent to the road, the officer was struck from behind by a motor vehicle traveling at ten to twelve miles/hour. He was seen by paramedics at the scene of the accident and taken to the ER where he was treated for whiplash and lacerations. Three days following the accident, he suffered a stroke. An MRI scan was performed which revealed an embolus extending from an atherosclerotic plaque in the right internal carotid artery near its origin, the carotid bulb. Embolic material was present in the right middle cerebral artery and the right anterior cerebral artery. There was no evidence of prenumbra in the superior portion of the right middle cerebral artery but there was in the inferior portion of the right middle cerebral artery. It was proposed by the treating physicians that the plaques became destabilized during the traumatic whiplash event of being struck by the vehicle, eventually causing the plaque to embolize three days later. Prior to the stroke, the man reported body ache and neck pain to his primary care physician. His primary care physician dismissed these complaints as non-emergency pain related to the accident.

Question(s) For Expert Witness

1. Could the traumatic event have contributed to the development of a stroke in this patient?

Expert Witness Response E-006758

The dislodging of a plaque due to trauma would be very unusual, but could have happened. The traumatic event could have contributed to the development of a stroke in this patient by dislodging a pre-existing plaque, however, more information about the patient’s past medical history would need to be known in order to fully assess his state of health prior to the accident. The fact that the patient reported neck pain to his primary care physician prior to the stroke may be significant here. More information would be required before making that determination. Another possible explanation could be that the patient suffered a dissection of the carotid artery during the trauma and this is what led to the stroke.