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.
About the author
Dr. Faiza Jibril
Dr. Faiza Jibril has extensive clinical experience ranging from primary care in the United Kingdom, to pediatrics and child abuse prevention at Mount Sinai Hospital, to obstetrics in Cape Town, South Africa. Her post-graduate education centered on clinical research and medical ethics. Dr. Jibril is currently Head of Sales in the US and Canada for Chambers and Partners - a world leading legal ranking and insights intelligence company.
