Imagine you are going about your day when suddenly you notice something just isn't feeling quite right. Perhaps there's some weakness in your arm. Maybe you're having some difficulty speaking. Or you suddenly have a terrible and unusual headache. Then a terrible thought crosses your mind. Could this be a stroke?
Immediately you run through the B.E. F.A.S.T. checklist to determine if you have stroke symptoms:
B - Balance: Loss of balance or coordination and dizziness.
E - Eyes: Trouble seeing out of one or both eyes.
F - Face: Droopy facial features, uneven smile or facial muscle weakness
A - Arm: Inability to raise arms evenly or weakness
S - Speech: Difficulty repeating simple phrases or impaired or slurred speech
T - Time: You must seek medical attention immediately by calling 911.
Recognizing symptoms associated with a stroke and quickly receiving medical attention could not only minimize the damage this affliction causes, but it might also just save your life. A delay in treatment, including misdiagnosis, could result in life-long disability or death.
In this blog, I outline the types of strokes, explain why there is such a high rate of misdiagnosis, note how misdiagnosis often results in poor outcomes for patients, and examine how misdiagnosis may qualify as medical malpractice.
Types Of Strokes, Symptoms, Misdiagnosis
Strokes occur when there is a disruption of blood to the brain. Without blood flow to provide oxygen and nutrients to the brain, cell damage and cell death begin to occur in the brain area that is affected.
There are two major types of strokes. Ischemic strokes, which occur in about 80-90 percent of cases, are caused by a blood clot that blocks or restricts blood vessels or arteries in the brain. A hemorrhagic stroke, which occurs in about 10-20 percent of cases, occurs when a blood vessel in the brain breaks and blood is lost.
In addition to the B.E. F.A.S.T. checklist, strokes symptoms can include sudden headache, vertigo, nausea, and confusion. Unfortunately, these kinds of signs are not unique to strokes, and misdiagnosis is common. For example, nonvascular diseases such as epilepsy, multiple sclerosis and hypoglycemia are called "stroke mimics" because patients present with stroke-like symptoms.
According to a major 2017 study of American patients presenting stroke symptoms at emergency departments, almost one in 10 suffered initial misdiagnosis. When the study looked at mild stroke symptoms or transient symptoms, the misdiagnosis rate reached 24 to 60 percent. Studies have found that stroke victims presenting with FAST symptoms, particularly hemiparesis and dysarthria, were more likely to be diagnosed accurately than patients with transient or resolved symptoms, altered mental status, nausea or vomiting, and dizziness and vertigo.
If a physician misdiagnoses an atypical stroke, it is unfortunate but not always legally actionable. If a physician did an adequate general and neurological assessment and gave appropriate instructions to the patient, failing to associate atypical symptoms with the possibility of a stroke would likely not be considered medical malpractice.
However, if the physician did not take steps to make a proper assessment or standards of care were otherwise breached, the resulting misdiagnosis could be medical malpractice.
For example, when peer experts reviewed the C.M.P.A.'s medical-legal stroke misdiagnosis cases, they were critical of fellow doctors:
– failed to recognize the severity of a patient's symptoms when there were red flags, including new or severe headache or focal neurological signs
– failed to perform complete physical and neurological examinations, visual field assessments and motor and sensory tests as appropriate
– developed an inadequate alternate diagnosis or anchored on such a diagnosis to the extent that impeded correct final diagnosis of a stroke
– failed to repeat neurological examinations if a patient's condition remained unchanged or deteriorated/evolved.
– relied too heavily on the sensitivity of C.T. scans to identify strokes
Particular criticism was also reserved for doctors who failed to consider a stroke diagnosis in patients with distinct risk factors (smoking, obesity, hypertension) or who had a history of subarachnoid hemorrhage.
The C.M.P.A. review also noted that insistences of misdiagnosis often involved not following appropriate clinical guidelines, delayed reporting or delayed contact with a treating physician with test results, communication problems between medical providers, and unavailability of testing equipment.
Misdiagnosing a stroke patient in the first few hours after they present with symptoms can have a devastating impact on their outcome. If a patient has suffered from the most common type of stroke - the ischemic stroke - they can be treated with t-PA, a medication that dissolves blood clots - but only within a short window of time. Research has shown that ischemic stroke patients who received this course of treatment within three hours of the onset of symptoms were at least 30 percent more likely to recover with little or no disability after three months. However, even if the patient first presents outside of this window, an initial misdiagnosis can still result in unnecessary delays in treatment and increase the risk and extent of permanent damage.
Help Is Available
Suppose the misdiagnosis or delayed diagnosis of a stroke has caused you or a loved one disability. In that case, it may be worth your time and effort to review your medical records with a personal injury lawyer to determine if your medical providers offered improper, unskilled or negligent care.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.