This case involves an elderly man who underwent revision surgery to correct an earlier procedure to implant a pacemaker. During the procedure, doctors attempted to place a line into the patient’s jugular vein in order to administer blood products, however it was discovered to be occluded. As a result, the surgeon elected to place a line in the subclavian vein instead. After the surgery was completed, the patient was brought out of the operating room and placed into the intensive care unit, where he experienced a seizure. Subsequent testing and evaluation discovered that the line had been placed into the patient’s artery rather than the vein, however, no evidence of an embolus was discovered on imaging studies, nor was any evidence of stroke. The patient continued to suffer from moderate encephalopathy after being released from the hospital, allegedly due to injuries suffered during the pacemaker revision surgery.
Question(s) For Expert Witness
- 1. Have you treated patient with encephalopathy following surgical procedures?
Expert Witness Response E-036010
Altered mental status is a common sequelae of surgery in my NeuroICU, as are post-operative seizures. Accidental intra-arterial injection of blood products could produce neuronal irritability and thus seizures; it would be important to know if any other products or drugs were also infused or if there were other potential causes of encephalopathy or seizures such as metabolic dysfunction, anesthetics, hypotension intra-operatively, for example. I have provided expert testimony for several cases of metabolic encephalopathy due to toxins, for example, carbon monoxide, and post-traumatic seizures. In this case, it is possible that the error in placing the line was responsible for the injuries suffered by the patient.
This expert is a board certified neurologist, who completed her MD at Case Western Reserve University School of Medicine and her fellowship in Neurocritical Care at the University of Cincinnati. She specializes in catastrophic and traumatic brain injury as well as headache and pain management. This expert has served as the Director of the Headache and Pain Center at Case Western Reserve University School of Medicine and the Medical Director for the Kentucky Headache and Pain Clinic. She has been awarded one of ‘America’s Top Doctors’ for six consecutive years and has appeared on several radio and television appearances presenting on topics such as migraine headache and chronic pain syndromes. She has authored numerous publications and books and received grants for continuing research trials.