Delayed Discovery Of Brain Aneurysm Results In Neurological Damage

Wendy Ketner, M.D.

Written by
— Updated on January 10, 2022

Urgent Care Expert

This case involves a middle-aged male patient with a history of elevated blood pressure who presented to urgent care with high blood pressure, headache and nausea. The patient was discharged with no diagnosis and was given prescriptions for pain relievers and anti-vomiting medication. He was instructed to return to the clinic if there was no improvement or if his symptoms worsened. The patient returned later in the week with elevated blood pressure. He was started on blood pressure medication and discharged. He presented on one more occasion with the same symptoms and was discharged with the same therapy. The patient later presented to the hospital and required a craniotomy surgery for a ruptured brain aneurysm. The patient suffered ongoing neurological deficits, along with other complications, from the delayed surgical intervention.

Question(s) For Expert Witness

  • 1. Do you routinely treat patients like the one described above?

Expert Witness Response E-008046

I frequently see patients with nausea, headache, and elevated blood pressure but I’ve never had a patient suffer from a ruptured brain aneurysm.  It is very unlikely that the blood pressure treatment the patient received would have prevented the brain aneurysm rupture. The treatment and management of blood pressure are not the responsibility of urgent care. The management of chronic medical problems falls primarily on primary physicians. The patient’s aneurysm was very likely present long before he ever presented to urgent care. There is no way to know or even suspect its presence based on the presenting symptoms described above. In my view, it is wholly unreasonable, and more likely dangerous, to suggest that all patients with elevated blood pressure and a headache go to the emergency room for advanced imaging. The fact that the patient was placed on blood pressure medications in the urgent care setting is beyond the scope of many urgent care centers and demonstrates a very good effort to reduce this patient’s blood pressure. Blood pressure management is a long-term process, where adjustments in medications are frequently not made in intervals less than 2-4 weeks. This center started her on 2-medications which demonstrates an aggressive initial attempt to lower this patient’s blood pressure. Based on the information provided, I do not think this outcome demonstrates professional negligence as there is no way to know a priori that an aneurysm is present and blood pressure reduction efforts had commenced. That those efforts were not successful in preventing aneurysm rupture is not a demonstration of professional negligence, it is a function of the patient’s genetic predisposition for aneurysm formation and perhaps many prior years of untreated hypertension.

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