This case takes place in South Carolina and involves a plaintiff who was diagnosed with a stroke and transferred to hospital, where she was treated by a hospitalist. She was placed in the ICU and given Xarelto. However, over the next few days, her level of awareness deteriorated. The hospitalist had a neurosurgeon evaluate her and, based upon the MRI’s, her brain had shifted and appeared to be herniated. They rushed her to the OR where surgery was performed to reduce the swelling. She is now incapacitated. It is alleged that had surgery been performed earlier and had she been referred to a neurologist she would have had a better outcome.
Question(s) For Expert Witness
- 1. Do you have extensive experience treating patients who have suffered from a stroke?
- 2. How soon should patient be treated and monitored after stroke has occurred?
- 3. Have you ever reviewed a similar case? Please explain.
Expert Witness Response E-009816
Yes I have managed plenty of patients with stroke, this sounds like malignant MCA syndrome. Well monitoring should take place right away , we have what we call “hemicraniotomy watch” where we keep close eye in icu on candidates, usually younger patients (less atrophy and thus less room for brain to swell) and big stroke. arguments are about when to intervene.. I cannot recall a case exactly like this one off top of my head
Expert Witness Response E-022027
I have been a board-certified Neurologist for 5 years. I am trained in Neurocritical Care, which makes me an expert in caring for critically ill patients including those with strokes. Acute life-saving treatment in acute ischemic stroke patients usually is provided within 48 hours. Such patients should be closely and carefully monitored in the intensive care unit from their presentation. Happy to assist with this case.