This case takes place in New York and involves a female patient who presented to the emergency room with the classic signs and symptoms of a stroke including slurred speech, dizziness, and weakness on one side. The patient was finally seen by a neurologist after a significant wait, at which time the order was given to perform an MRI, which confirmed the stroke. The patient was taken to another unit in the hospital, where her condition continued to deteriorate over the course of a week. The patient was eventually released from the hospital with extensive neurological damage, and will require a high level of supportive care fro the remainder of her life. It is the contention that the hospital staff treating this patient failed to timely and appropriately treat the patient’s symptoms within the accepted window for effective treatment.
Question(s) For Expert Witness
- 1. How should a patient be screened for the administration of tPA?
- 2. Is an elevated blood glucose an absolute contraindication to the administration of tPA?
Expert Witness Response E-007101
In regards to your questions, patients should be screened for eligibility for more aggressive treatment if they present within 4.5 hours of the onset of symptoms or signs that indicate acute brain dysfunction and there are no obvious non-vascular causes. In these cases, patients should rapidly undergo a head CT or MRI to rule out brain hemorrhage. Then, there is a standard checklist of inclusion and exclusion criteria that should be checked to determine eligibility. I have often treated patients with suspected stroke even if the glucose levels were elevated.