Final Update: Delayed tPA Lawsuit
I first published Case #15 over 2 years ago.
The final defendants have now settled.
A 48-year-old man had been found unresponsive.
His last known normal was ~6:30pm, and he arrived to the ED by ambulance at 7:45pm.
A head CT was done and reported as negative for any acute findings.
The radiologist allegedly failed to report a dense left MCA sign.
An MRI was done, revealing a stroke.
Neurology was consulted and the patient was given tPA just under the 4.5 hour window.
The patient survived but had severe residual deficits.
The EM doctor settled the case several months ago.
The neurologist and both radiologists (attending and resident) have now settled as well.
A few thoughts:
Stroke patients who arrive with altered mental status often have a delayed diagnosis, as compared to stroke patients who arrive with unilateral weakness. This is especially true when EMS does not trigger a stroke activation. This exact same theme is visible in this case, as well as the Locked-In Syndrome case that was published a few weeks ago. Both of these cases are in relatively young patients as well (48-years-old and 32-years-old).
In patients with sudden-onset altered mental status without a clear alternative cause, consider a stroke activation.This ED physician was able to get an MRI done and still give tPA within the 4.5-hour tPA window. Having rapid access to MRI can help avoid catastrophes. This was much faster than last week’s case in which the attorney accused the MRI department of being extremely slow.