Medical Malpractice Case Report: $1.2 million settlement for failure to properly assess, diagnose, and treat cerebral aneurysm

Reached a $1.2 million settlement after a failure to diagnose, properly assess, and treat a cerebral aneurysm resulted in permanent neurological injury.  Read the following Minnesota Case Report from the Minnesota Association of Justice (MAJ) Minnesota Case Report:

Selected Results*  

(Excerpts taken with permission from Minnesota Association for Justice (MAJ) “Minnesota Case Reports”)

On August 17, 2000, our client presented to defendant Clinic complaining of a severe headache of six days duration with light sensitivity, episodes of nausea and vomiting.  Dr. S. took a history, examined her, and diagnosed a migraine status attack.  He admitted her to Hospital for treatment with IV fluids, Pain medications, and anti-nausea drugs.  Our client had a history of migraines, but never before had a headache so severe or unremitting that it required hospital admission.  Dr. S. ordered a CT Scan of her head, noting "history of migraine headaches + worse headache now."

On August 18, 2000, defendant family practitioner assumed her care.  Her severe headache, photophobia, and nausea persisted.  Head CTs with and without contrast were completed and read by defendant Radiologist who interpreted the scans as showing "question nodules, bilateral parietal convexity cortex."  He did not identify or report any evidence of a cerebral aneurysm or bleeding abnormality (subarachnoid hemorrhage) in her brain. His written report recommended an MRI.

Plaintiffs' expert radiologist would have testified that the August 18, 200 CT scan with contrast shows an enhancing structure which is strongly suspicious for an aneurysm in the region of the anterior cerebral artery, and a suggestion of bleeding. He would have testified that defendant radiologist departed from accepted standards of care by failing to identify and communicate those abnormal findings.  Such findings are consistent with an aneurysm, pose a threat of serious injury or death to the patient, and demand immediate recognition and follow-up with MRI and / or cerebral angiography on an urgent basis.  Those tests likely would have revealed the aneurysm, making earlier treatment possible.

Our client remained hospitalized under the care of defendant family practitioner until August 20, 2000.  Throughout her admission, her headache and nausea waxed and waned.  Despite treatment with narcotics, sedation, other migraine pain medication, ice to her head, and resting in a darkened room, her headache persisted to the day of her discharge.  At 6:00 a.m. on August 20, 200, nurses notes document D.B. complaining of a frontal headache she described as 3-4 on a severity scale of 0-5.  She was given pain medication and ice to her forehead.  At 7:40 a.m. she was in a dark room with an ice bag to her head, still complaining of a frontal headache.  At 11:35 a.m., she was discharged to her husband and home per defendant family practitioner orders.  He never advised our client of the radiologist's recommendation for an MRI or ordered the MRI.

Following admission to the hospital, it was apparent that our client's headache was more severe and different from her prior headaches, in that there was very little, if any improvement in her symptoms with appropriate medication therapy.  Dr. S.'s CT scan order describing "worst headache now" is a classic description associated with brain aneurysm. Defendant family practitioner was not in a position to judge whether the "nodules" referenced in defendant radiologist's report were or were not the cause of our client's symptoms.

After she was discharged to home, our client's headache continued.  Two days later, on August 22, 2000, she woke up confused, had difficulty getting our to bed, and had trouble communicating.  Her husband brought her to Hospital ER where she was again evaluated by defendant family practitioner.  She had difficulty walking and responding to his questions.  He initially believed she was have a drug reaction or psychiatric problem.  He admitted her for observation and ordered a head CT scan.  The August 22, 2000 CT scan, read by defendant radiologist, showed massive bleeding in her brain.  The small leak from the aneurysm shown on the August 18, 200 CT scan had progressed to a rupture.

She was air lifted to a different hospital where neurosurgical repair of the ruptured aneurysm could be performed.  An August 22, 2000, neurosurgeon Dr. J. successfully clipped the aneurysm.  Our client remained hospitalized until the end of September, 200. During that time she suffered massive complications of her brain hemorrhage, including post-operative cerebral vasospasm, causing strokes and left-sided paralysis.

The plaintiffs' expert neurosurgeon would have testified that if our client's leaking aneurysm had been diagnosed anytime prior to its full rupture, accepted standards of practice required that she be sent for an angiogram to confirm the aneurysm.  If such treatment had been undertaken before the rupture on August 22, 200, it is more likely than not that she would not have suffered any permanent neurological injury.

This cases was defended most vigorously on causation.  Although all of the experts agreed that the headache that lead to our client's hospital admission was caused by small sentinel bleed from aneurysm, defendants' expert opined that this small bleed would have so increased her risk of vasospasm as to contraindicate surgery for her until a date that was after the date her aneurysm ruptured.