Failure To Obtain Neurology Consult Allegedly Causes Patient's Stroke

Case Overview

This case involves an 80-year-old female patient in Maryland with a past medical history of a stroke who went into the hospital for hip replacement surgery. The patient was taking daily ibuprofen but was told to discontinue the medication one week prior to the procedure. The hip replacement surgery was successfully completed and the patient was discharged home. Less than 2 hours after being discharged from the hospital, the patient collapsed. The patient’s granddaughter called 911 and EMS arrived within 15 minutes. The patient presented to the emergency room and was ordered a state CT. The CT revealed hemorrhaging but no area of infarct. However, an MRI was never obtained and no neurologist was consulted. The patient was transferred to a stroke center but passed away en route. It was alleged that a timely neurology consult could have changed the patient’s outcome.

Questions to the Neurology expert and their responses

Do you routinely treat patients similar to the one described in the case? Please explain.

I have 25+ years of experience in vascular neurology. As the director of the stroke unit at a major hospital, I routinely treat stroke patients.

What could have been done for the patient to avoid such an outcome?

Patients with high-risk profiles should be treated with a high level of suspicion to avoid such an outcome. I can certainly speak to the efficacy of administering anticoagulants or tPA for the patient as soon as possible. The quicker the intervention, the better the outcome.

About the expert

This expert has over 25 years of experience in the field of neurology. He earned his BA in chemistry and physics from Harvard University and his MD from Harvard Medical School. After completing his residency in neurology at Massachusetts General Hospital, this expert remained there to complete a prestigious fellowship in the same discipline. Today this expert is board certified in neurology and vascular neurology. In addition, this expert has published dozens of peer-reviewed journal articles and a book chapter in his field. Formerly, he served as an assistant professor of neurology for two Ivy League institutions and as an associate professor of neurology at the NYU School of Medicine. He also served as the vascular neurology chief, stroke center director, and an attending physician at North Shore University Hospital. Currently, he serves as an attending physician in neurology, the director of the stroke unit, and the director of the neurovascular laboratory at a major medical center in New York. Additionally, he is an associate professor of neurology at an Ivy League medical school.