Delay in Stroke Treatment Permanently Incapacitates Patient

Case Overview

This case takes place in South Carolina and involves a plaintiff who was diagnosed with a stroke and transferred to hospital, where she was treated by a hospitalist. She was placed in the ICU and given Xarelto. However, over the next few days, her level of awareness deteriorated. The hospitalist had a neurosurgeon evaluate her and, based upon the MRI’s, her brain had shifted and appeared to be herniated. They rushed her to the OR where surgery was performed to reduce the swelling. She is now incapacitated. It is alleged that had surgery been performed earlier and had she been referred to a neurologist she would have had a better outcome.

Questions to the Neurology expert and their responses

Do you have extensive experience treating patients who have suffered from a stroke?

Yes I have managed plenty of patients with stroke, this sounds like malignant MCA syndrome.

How soon should patient be treated and monitored after stroke has occurred?

Well monitoring should take place right away, we have what we call 'hemicraniotomy watch' where we keep close eye in ICU on candidates, usually younger patients (less atrophy and thus less room for brain to swell) and big stroke.

Have you ever reviewed a similar case? Please explain.

I cannot recall a case exactly like this one off top of my head.

About the expert

This highly qualified expert is certified by the American Board of Psychiatry and Neurology and the National Board of Medical Examiners. He received his Bachelor of Science in Electrical Engineering from St. Louis University and his medical degree from the University of Arkansas for Medical Sciences. He also has an MS degree in Engineering Design and Economic Evaluation from the University of Colorado at Boulder. He completed an internship at the University of Arkansas for Medical Sciences in Little Rock, and neurology residency in the Department of Neurology at the Medical College of Georgia in Augusta. He was formerly the Presidential Distinguished Chair, Regents Professor of Neurology, and Co-Director of the Cerebrovascular Section in the Department of Neurology at the Medical College of Georgia in Augusta, Georgia. After his time in Augusta, this expert moved to a respected South Carolina University and assumed the titles of University Eminent Scholar, Professor of Neuroscience and Director of the South Carolina Center for Economic Excellence in Stroke. He is an active member of numerous professional societies, including the American Academy of Neurology, the American Medical Association, the American Heart Association (AHA), the American Stroke Association, the American Neurological Association, and the American Society of Hematology. He is the past Chair of the Stroke Council Leadership Committee, and past chair of the American Stroke Association Stroke Advisory Committee. In addition to his extremely active clinical career, this doctor has published more than 60 peer-reviewed articles, including 3 original publications in New England Journal of Medicine, and numerous book chapters and reviews, and has participated in guideline and scientific statement development on various aspects of stroke management through the AHA/American Stroke Association, the American Academy of Neurology and National Heart Lung and Blood Institute. His primary research activities are in stroke prevention and novel delivery programs of stroke care.