Neurologist's Workup of Stroke Patient Contributes to Cerebral Death

Case Overview

This case involves a seventy-seven-year-old woman with a medical history of hypertension, hyperlipidemia, and infrequent palpitations who presented to the hospital with an acute onset of slurred speech. The patient arrived outside of the window period for the administration of tPA and doctors advised that no other medical intervention was indicated other than supportive care. Subsequently, the patient was admitted to the stroke unit for further observation but at no time was an EKG, neuroradiology, or any other cardiac testing performed to rule out an embolism as the cause of the stroke. Three days into her hospital stay, the patient again displayed significant signs of stroke and was no longer able to support her own airway. She was placed on a ventilator and further brain imaging showed extensive cerebral damage consistent with brain death. The patient’s family elected to remove her from the respirator and she died shortly thereafter.

Questions to the Pediatrics expert and their responses

What additional tests could have been performed to alter this patient's outcome?

Because paroxysmal atrial fibrillation (PAF) episodes are often subclinical, ambulatory ECG monitoring was a reasonable additional evaluation in this patient and may have helped to prevent the fatal embolism.

About the expert

This expert is one of the world's experts on the diagnosis and management of central nervous system tumors involving the auditory nerves, and has been practicing medicine for over 40 years. He has served on various committees and governmental agencies and his clinical contributions include creating a clinic and counseling program for Neurofibromatosis. He has previously held a private practice in neurology and is a part time CEO of a privately held drug development effort for orphan neurological disorders. Finally, he has many patent applications, publications in journals and books, and has presented invited lectures at national conferences.