Post Operative Hemorrhage Leaves Patient In Permanent Vegetative State

    Neurosurgery Expert

    This case involves a 28-year-old male patient with a history of drug-resistant epilepsy in the temporal lobe. The patient underwent a temporal lobectomy and amygdala hippocampectomy. During the procedure, a significant portion of the hippocampus was removed along with the majority of the uncus. The surgery was completed with no complications noted in the operative report. The patient was then transferred to the post-anesthesia care unit. Upon his arrival, the staff had difficulty reviving the patient from the anesthesia. A CT scan of the brain revealed a massive hemorrhage centered on the thalamus. The patient remained in a permanent vegetative state. It was alleged that the defendant neurosurgeon failed to take sufficient action to evacuate the hemorrhage and limit the degree of injury.

    Question(s) For Expert Witness

    • 1. Please describe your background in neurosurgery.
    • 2. How often do you perform these procedures?
    • 2. What are the common complications of this surgery?

    Expert Witness Response E-064403

    I am board certified in neurology, clinical neurophysiology, and epilepsy and have been in practice for 21 years. I am also an associate professor of neurology, and I specialize in epilepsy and epilepsy surgery. I currently work at a level 4 epilepsy center which performs these types of surgeries, and I frequently see patients that have temporal lobectomies. I have lectured and published on many epilepsy topics, including epilepsy surgery and persistent vegetative state. I have seen many strokes working at a major academic and county facility. This is a very unfortunate result. Epilepsy surgery is elective surgery and unfortunately, there is a small risk of stroke. Strokes can be ischemic or hemorrhagic. Ischemic strokes are either embolic or thrombotic. This patient’s stroke was a hemorrhagic stroke, and in the setting of brain surgery suggests damage to a blood vessel. A bleed in the thalamus with extension to the midbrain is dangerous, as the midbrain is part of the brainstem and damage there is most devastating as it is important for consciousness. The hemorrhage could have been evacuated to limit the degree of cerebral injury and hopefully improve outcome. This may be the most important detail in the case, as this is a treatment for hemorrhagic stroke, especially when it is massive. In the presurgical workup, some patients get a WADA test (intracarotid Amytal test) and there is a cerebral angiogram which gives the most detailed information about the cerebral vasculature.

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