This case involves a man in his mid 40s who presented to the ER early in the morning. He had an acute onset of nausea and a severe headache. Additionally, he had an elevated blood pressure and was struggling to breathe. He was admitted to the hospital with a diagnosis of abdominal pain with little explanation for his symptoms. 4 hours after being admitted, he started feeling numb on his right side, but despite the appearance of this new symptom, the nurse did not investigate further or report it to a doctor. By late evening, the patient was found unresponsive. A CT scan was ordered which revealed significant swelling of the brain and neurosurgeons concluded he had a massive cerebral stroke. Although emergency procedures were performed soon after the diagnosis, he died later that day.
Question(s) For Expert Witness
1. Given symptoms noted above, does the standard of care require an imaging study or a neurologic/neurosurgery consult?
2. If the patient is admitted to the hospital with a GI or abdominal issue diagnosed, but with vertigo, dizziness and headache and there is a change in altered mental status, slurring of speech and worsening headache, what work up should be done?
3. Have you ever reviewed a similar case? If yes, please elaborate.
Expert Witness Response E-004640
This patient had neurological symptoms and complaints. At the minimum, she needs a head CT and a detailed neurological consultation. Given the acute onset of her symptoms, a stroke is very high on the differential and she needs vascular imaging.
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