For eight years in the 1990s, Attorney Charles Ware hosted the extremely popular legal advice radio program "The Lawyer's Mailbox"; the Number One (#1)legal advice radio program in the Mid-Atlantic Region,on WEAA - 88.9 FM, Morgan State University Radio in Baltimore, Maryland.
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Thursday, February 20, 2014

MARYLAND STROKE MED. MAL. CASE REVIEW: Was tPA Required ?

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Expert Neurologists have opined that "tPA" (Tissue Plasminogen Activator) was not "Indicated" (Required) in the following medical malpractice " stroke" case:


A 74 year-old male who became dizzy with left-sided weakness at home when getting up from bed
fell into the bed post, injuring his eyebrow with bleeding on June 25th,2009 at approximately 3:48 a.m.  An ambulance was called and the patient advised EMS that he had noticed left-sided arm and leg weakness as well as left-facial droop with slurred speech at the same time. He was taken by EMS ambulance to the nearest hospital where the records reflect he was sent for a CT scan.


After the first CT scan, his symptoms temporarily resolved and he was able to move his left arm. Then suddenly, approximately 15 minutes later he developed symptoms again, including left tongue deviation, left facial droop, left sided paralysis, weakness, and difficulty lifting with left arm. No tPA
was administered according to the records because the physicians evaluating him felt that he had the resolution of symptoms  ( tPA  is used in some cases of diseases that feature blood clots, such as pulmonary embolism, myocardial infarction, and STROKE, in a medical treatment thrombolysis. The most common use is for ischemic stroke ). The stroke team was called and they decided to start him on Heparin. A cardiovascular assessment was performed, including an electrocardiogram, and a second Ct scan revealed no intracranial hemorrhage. The patient's symptoms seemed to continue to reappear, then disappear, reappear and the was a CVA. The team felt they would then start Coumadin dosing for DVT.


The CT scan of 06/25/2009 revealed old Left Basilar ganglia/Lentiform Nucleus infarct and periventricular white matter changes without evidence of acute parenchymal hemorrhage, edema or mass effect. On 06/27/2009 he had another CT scan which revealed an acute infarct now in the right pons. Ultrasound of the lower extremities revealed no evidence of DVT. Subsequently, an ICD was placed in the patient; a Regadenson perfusion study was performed was revealed evidence of infarction in the LAD and RCA territories; and a Gated analysis revealed multiple regional abnormalities consistent with infarction.


He was ultimately discharged to a rehab center but continued with left-sided weakness and paralysis.
Despite his lasting medical defects, our neurologist experts opined that his treatment for a possible was not inconsistent with established standards of medical care.


[ http://www.medquestltd.com/iTPA not indicated for stroke patient/ 02-20-2014; EC 3.4.21.68 (http://enzyme.expasy.org/EC/3.4.21.68]

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