Misdiagnosis of Brain Hemorrhage Leads to Extensive Hospitalization

Case Overview

This case takes place in Minnesota and involves a 70-year-old patient who presented to the ER with dizziness and instability, after a period of exercise. She underwent an MRI and nothing showed up except some inflammation in the sinuses. The patient was diagnosed with a sinus infection and was started on treatment. She was admitted for monitoring. Approximately twelve hours later the patient’s condition had deteriorated such that a second MRI was performed which identified a diffuse subarachnoid hemorrhage. The patient underwent surgery to relieve the pressure. She was discharged home after five weeks in hospital and a rehab unit.

Questions to the Neurology expert and their responses

How often do you treat patients with these presenting complaints?

When I am covering the ER, we see a patient with new onset dizziness and ataxia about once per week.

What is the standard work up for these patients?

The work up typically involves a neurological examination with special maneuvers to evaluate for vestibular (inner ear) dysfunction as a cause of the symptoms. If the patient has stroke risk factors and cannot be definitively diagnosed with vestibular dysfunction, we get an MRI and, depending on the prior probability for stroke and the degree of ataxia, we might admit the patient for a complete stroke work up and/or PT assessment. If symptoms persist and/or new neurological symptoms develop, it is likely that imaging would be repeated. If the patient's symptoms were advancing (new problems, not just worsening dizziness), we would likely obtain a CT angiogram to assess for posterior circulation stroke.

About the expert

This board-certified expert has over 10 years of experience in the field of neurology. In addition to serving on various national and international committees, she currently serves as Professor of Neurology and Associate Director of the Center on Human Development and Disability at a major medical university where she has researched and published extensively in the field. She is currently exploring how the brain responds to a variety of injurious stimuli, which may shed light on situations such as trauma, seizures, inherited neurodegenerative disease, and mitochondrial disease.

E-007492

Specialties:

Neurology