As a Houston, Texas medical malpractice lawyer who’s handled various stroke cases, I’ve noticed a health care paradox.
Everyone agrees that stroke care is time sensitive and that people should get to the emergency room (ER) at the first sign of trouble. Yet, those patients who make it to the ER with early symptoms that come and go are often discharged without much of a workup. This can lead to misdiagnosis, lack of treatment, a massive stroke, and a medical malpractice lawsuit.
A September 2019 article in the peer-reviewed journal JAMA Neurology shows that researchers are re-thinking this failed practice.
When patients are diagnosed with transient ischemic attack (TIA) or stroke, they have a higher risk of having another stroke in the near future. The highest risk is within the next 48 hours. There’s still a heightened risk a few weeks out. TIA or stroke patients with these symptoms have the highest rates of experiencing another stroke in the short-term:
• Motor weakness (difficulty moving extremities or walking)
• Aphasia (slurred speech, word-finding difficulty, or other problems speaking)
• Prolonged symptoms
The good news is that there are medical treatments that doctors can order to prevent patients from having another stroke. Because of the risks of those treatments, though, they shouldn’t be ordered without a clear diagnosis of TIA or stroke.
That’s where the bad news comes in. It takes time and energy to make a correct diagnosis, particularly in the early stages of stroke or TIA. And sometimes doctors and stroke teams aren’t willing to make that investment and, instead, downplay, ignore, and discharge patients with intermittent or transient stroke/TIA symptoms that come and go or have a shorter duration.
That’s exactly what happened to a Painter Law Firm client who went to a hospital ER in The Woodlands immediately after developing sudden symptoms of vertigo (dizziness). Without ordering a CT or MRI scan, or doing much of an evaluation at all, the ER doctor concluded that his symptoms were temporary and sent him out the door. He retuned the next day — as he was experiencing a massive stroke that could’ve been avoided.
This new JAMA Neurology study focused on providing MRI scans even to patients who didn’t have high scores on the standardized stroke scale. Their study group included patients with no history of stroke, no significant past medical history of disability, nonmotor or speech symptoms of any time duration, and patients with motor weakness or language problems that lasted 5 minutes or less.
The researchers found that MRI imaging led to a change in diagnosis in 30% of the patients in the study. Of the lower-risk TIA/stroke patients included in the study group, over 13% had MRI evidence of at least one area of brain damage (lesion).
I found one of the conclusions of the study to be particularly telling. ER doctors and even stroke teams often believe that when any of these symptoms are present, the diagnosis should be something other than a stroke: emotional stress or anxiety, symptoms lasting less than 5 minutes, and symptoms progressing slowly rather than coming on suddenly. This study debunked that general belief, finding no correlation to a lower risk of stroke damage to the brain on an MRI.
Let’s hope that ER and stroke providers pay attention to this promising new study, start listening to their patients’ complaints and symptoms, and begin consistently ordering the necessary tests, including MRI scans, to make correct diagnoses and treatment decisions.
If you’ve been seriously injured because of poor emergency room or hospital stroke care, then contact a top-rated Houston, Texas medical malpractice attorney today for help in evaluating your potential case.