This case involves an elderly woman who presented to the emergency department in Kansas after experiencing a complete loss of sensation in her right arm. She also complained of severe neck pain. In the emergency room, an MRI of the woman’s cervical spine was performed, however, no additional testing for a possible stroke was performed. The emergency room physician diagnosed the patient with cervical radiculopathy, referred the patient to outpatient follow up with a neurosurgeon, and discharged the patient home. Several days later, the patient saw her primary care doctor complaining of severe neck pain. The doctor agreed that the patient was suffering from cervical radiculopathy, and referred the patient to outpatient physical therapy. The next day, the patient suffered a massive stroke causing paralysis to most of her right side. It was alleged that more comprehensive workup was warranted when the patient first presented to the emergency room.
Question(s) For Expert Witness
- 1. If a radiologist diagnoses cervical radiculopathy should the radiologist recommend brain or vascular imaging?
- 2. Can "mild degenerative disease" on cervical spine MRI explain acute left sided upper extremity weakness?
Expert Witness Response E-059652
A radiologist would not be expected to recommend additional studies based on an indication of extremity weakness or neck pain if an MRI cervical spine has been ordered and shows radiculopathy. If a stroke were suspected based on clinical evaluation of the patient’s symptoms, the referring clinician would be the one placing a request for a CT or MRI head. From the history provided, it appears that a stroke work up should have been pursued at the initial evaluation by the referring clinician. In isolation, “mild degenerative disease” connotes that there was no significant degenerative change that would account for the loss of sensation. However, other findings could contribute to loss of sensation on MRI, that could be superimposed on mild degenerative changes, i.e. a cord lesion, for instance.