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A 40-year old female presented to an Emergency Room(ER) on June 11th due to increasing instances of debilitating migraine headaches. The CT scan came back negative and she was released to follow up with a neurologist for possible MRI tests. Appointments were not made.
Three weeks later she returned to the Emergency Room and had after developing aphasia (language impairment) overnight, and she was unable to communicate beyond one or two word sentences. The hospital staff ignored the new symptoms of aphasia, performed no further studies or observations, and had her involuntarily committed to their mental health unit where she was detained for a week. By the second day in the mental health ward the aphasia was wearing off.
On the last day of the 5-day mental health stay, the Patient finally got her previously-requested neurology consultation. The neurologist suggested that she follow up in his office the next day. He subsequently ordered an MRI while awaiting insurance approval. The Patient was afraid to wait and checked into a 2nd Emergency Department. The staff there immediately took a CT scan and compared it with the one from Hospital #1 on June 11th. A lesion was found on her brain and an MRI was taken the next day.
The MRI revealed that she had had an AVM (stroke) on July 17th. She had a craniotomy(skull opening) to remove the legion.
She currently suffers memory loss, balance issues , and requires speech and occupational therapy.
ISSUES : Could the stroke have been prevented? Did the one month delay change the type of surgery that was necessary?
Generally, some experts believe the stroke likely could have been prevented; although the Patient is generally faulted for not following up with a neurologist as the ER recommended.
[See, www.medQuestltd.com/ ER Failure to Dx and Treat Stroke]
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