This case involves a 32-year-old woman, who underwent a pancreas transplant. The following year, a cyst was found on her pancreas and she went to the hospital for a pancreas biopsy. During the biopsy, the small intestine was perforated and the patient quickly became ill. After the biopsy, the patient informed the nurse she could no longer feel her lower limbs. A neurologist was consulted, but an MRI was not completed until 4 days later. From the MRI, it was concluded that the patient suffered an infarct of the thoracic segment of the spinal cord. She remains paralyzed from the hips down, and requires a wheelchair.
Question(s) For Expert Witness
- 1. Are you familiar with the type of patient described above?
- 2. Have you seen a patient with this complication?
- 3. Are you familiar with the interventions and the timing of the intervention necessary to improve prognosis in a patient with an infarct to the thoracic segment of the spinal cord?
Expert Witness Response E-028269
I have seen patients with this condition and have seen patients with this complication. His blood pressure dropped significantly so that the thoracic cord suffered a stroke. Iit exists in a so-called “watershed” area so is most vulnerable to that. An analogy would be a third-story bathroom with less water supplied by pipes than other rooms. If the water pump fails, other rooms would still get water but not that bathroom. It is not the delay in MRI which caused irreversible damage. The diagnosis should be clear on clinical grounds and the only treatment is rapid return to normal blood pressure, i.e. tPA would not have helped, nor neurosurgery.