Hospitalist Expert Witness Opines on Delayed Resection of Brain Tumor

This case involves a thirty-year-old woman who presented to the urgent care clinic with headaches. She was prescribed pain medications and discharged home. Two days later, she presented to the emergency department with the same chief complaint. A CT scan with contrast was ordered which revealed a mass in the posterior fossa. Neurosurgery was consulted, and the patient was transferred to a nearby hospital. The decision was made by the hospitalist and neurosurgeon to wait to perform an awake brain surgery procedure the following day, but the patient died that evening. The plaintiff alleged that mismanagement caused deterioration of this patient until she expired.

Question(s) For Expert Witness

1. Can a delay in the management of a brain neoplasm cause rapid deterioration and death?

Expert Witness Response E-000497

Most likely the patient herniated from the increased pressure and died from this. I think that the CT scan results and specific signs of increased Intracerebral pressure through info on physical exam, CT results, clinical picture, vomiting presence, etc. would be critical pieces of information to further determine this patient's condition state and appropriate management. Brain stem herniation is most likely the cause of death. Prompt management and excision of the mass to relieve the pressure on the brain stem, thus preventing mortality.