Most medical malpractice lawsuits involving stroke care are based on allegations that a doctor or hospital failed to diagnose the stroke in time, or failed to administer the clot-busting drug known as tPA (tissue plasminogen activator). There is only a short window of time to administer tPA and break up a clot before major brain cell damage becomes permanent.
The time period when tPA should be used varies depending on very specific published criteria. The time period starts running when a person’s symptoms first begin, so obtaining that information from the patient or patient’s family members is extremely important.
Initial reports about the effectiveness of tPA indicated it was only helpful around 30% of the time. Later studies have proven the effectiveness is much higher than that.
Unlike the failure to give tPA, failing to give heparin or warfarin (Coumadin) for a stroke is not usually a good basis for a medical malpractice case. These medications have not been proven to be of much value for most strokes, or for transient ischemic attacks (TIAs). However, Warfarin is used for emboli coming from the heart. Also, there may be malpractice liability for failing to restart Warfarin after stopping it for other reasons (like dental surgery), if the patient then suffers a stroke.
Because strokes in young people are relatively uncommon, health care providers are sometimes slow to recognize the signs and symptoms of stroke when the patient in front of them is younger than the “typical” stroke patient. For patients both young and old, but especially for otherwise healthy young people, unnecessary delays can lead to a lifetime of crippling disability, or death.
Strokes can happen at any age, but when strokes happen in otherwise healthy young people, they are most often caused by what is known as a vertebral artery dissection (“VAD”). VAD is often completely painless, and can happen with even the slightest stretching of the neck. Not every VAD goes on to cause a stroke.
A VAD is a flap-like tear of the inner lining of the vertebral artery, which is located in the neck and supplies blood to the brain. Blood starts accumulating, and therefore, clotting, where the tear is located. A stroke can be caused when a piece of clotted blood breaks off and travels up the artery, getting stuck, and preventing blood flow to an area of the brain. When blood stops flowing to parts of the brain, brain cells are deprived of oxygen, and die. The changes that occur to the brain when it is deprived of oxygen are called ischemia.
Common activities known to cause VADs include:
Because there is a very narrow time window for effective treatment of stroke, knowing how to recognize the signs and symptoms of stroke can mean the difference between life and death.
Some common signs and symptoms of stroke include:
When a patient arrives in the emergency department with a suspected stroke, one of the first steps is to obtain an immediate CT scan. CT scans detect the presence of blood outside of the arteries in the brain. This is important because there are two types of strokes: those caused by bleeding (called hemorrhagic strokes), and those caused by clots (called ischemic strokes). The vast majority of strokes are caused by blood clots. If there is no evidence of bleeding shown on the CT scan, then the patient may be eligible for tPA if other criteria are met. If there is evidence of bleeding, or hemorrhagic stroke, then the patient is not a candidate for tPA.
The front-line treatment for ischemic stroke is a clot-busting drug called tPA, given within 3 hours of onset of stroke symptoms. For certain patients, the drug can be given up to 4.5 hours after onset of stroke. After 4.5 hours, the risk of life-threatening bleeding outweighs the benefits of the drug. This 3 to 4.5 hour timeframe is sometimes referred to as the “window” for treatment. In some stroke centers, depending on the type of stroke, tPA may be given up to 12 hours or more after onset.
The sooner a patient gets tPA, the better. In other words, the same patient, if given tPA at 90 minutes after the onset of symptoms, will do better than if they were given the drug at 2 hours from onset. This is why getting a stroke patient to the hospital as quickly as possible is so important.
tPA is not the only treatment available for strokes caused by clots. Some patients may be candidates for a different treatment, in which a specialist (often an interventional radiologist) physically removes the clot from where it is lodged in the patient’s artery using a special device. This treatment is called mechanical thrombectomy. Depending on the location of the clot, the size of the stroke, and the general health of the patient, mechanical thrombectomy has been known to be successful in restoring blood flow as many as 8, 12, and even 24 hours from the onset of stroke symptoms.
For patients with hemorrhagic strokes, surgery may be necessary to relieve pressure building up inside of the skull. Not all facilities have neurosurgeons available on staff, and transfer to a facility that has a neurosurgeon may be necessary.
Malpractice cases may be based on the failure to administer tPA or the failure to transfer the patient to a more appropriate hospital (such as a Certified Stroke Center), where appropriate treatment can be given before it is too late to help.
Some stroke patients die, and some survive but must endure a lifetime of disabilities. The families of stroke victims are often unexpectedly left in the position of caring for a previously able-bodied person, which can take a tremendous toll both emotionally and financially.
A consultation with an experienced stroke medical malpractice attorney at our firm is always free. We routinely investigate stroke care, with a keen eye towards assessing whether different care should have been offered and whether it would have resulted in a significantly better outcome for the patient.