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Patient Dies After Doctors Misdiagnose Brain Aneurysm

A woman spent two years going back and forth between her personal care physician and an internist, seeking relief from her daily headaches. She died because the doctors did not perform basic tests to investigate the cause of her headaches, which was an aneurysm.

Instead, her doctors tried various medications, various dosages and even suggested counseling. The headaches got so bad at one point that they were waking her up. But not once did these doctors perform any diagnostic tests on the woman, nor refer her to a neurologist. There was no communication between the two doctors.

Finally, two years after her first complaint to the internist, she self-referred herself to a neurologist for evaluation of her headaches. But unfortunately for this woman, she still did not get an answer as to what was causing her headaches. No diagnostic test was performed again. Rebound headache was the official diagnosis.

Within two weeks after that visit, this otherwise healthy woman died of a brain aneurysm after being found slumped over her steering wheel at a red light.

The 55-year-old woman had gone to the internist after hearing him give a talk on migraine headaches. She had a history of depression, headaches, anxiety and anorexia nervosa. She had suffered headaches since age 21, with a remission after menopause. But now the headaches were a daily occurrence.

She was diagnosed with chronic depression, transformed migraine headaches and chronic insomnia. After the patient started on Depakote for her headaches, she experienced short-lived relief, but during the following five months the pain returned in full and eventually she was switched to Zoloft and Ambien. After the internist referred the patient to counseling, she never returned.

Instead, the patient went to see her personal care physician, complaining of daily migraine headaches. Her physician said stress and caffeine were the causes and she was given Tylenol, Klonopin and aspirin.

A year later she returned. Now the headaches were waking her up. She was started on a new medication and began counseling, which her physician had also recommended.

She went to the neurologist and her exam was normal. More medication was prescribed.

Two weeks after this neurology appointment, the patient was found slumped over the steering wheel at a red light. A CT scan at the hospital revealed a large, right temporal parenchymal hematoma, or bleeding inside the brain. There was also a right subdural hematoma, or bleeding on the surface of the brain.

The patient had fixed pupils and continued to be unresponsive. CT revealed multiple aneurysms, (the largest in the middle cerebral artery). After emergency surgery, the patient developed asystole or no cardiac activity for 30 minutes, and the patient was pronounced dead

The patient’s family sued her physician, the internist, and the neurologist for her alleged wrongful death as a result of delayed diagnosis of cerebral aneurysm. The jury found for the plaintiff, for more than $500,000.

This wrongful death case was strong because it involved a death in an otherwise healthy woman, and several providers all failing to correctly diagnose a problem as possibly non-psychological.

Other factors that led to this successful claim include:

The internist and physician both treated the patient’s condition as chronic and did not order any diagnostic tests. Even when she self-referred to a neurologist, he also chose not to order any diagnostic studies. Providers who rely on a previous clinician’s diagnosis, without an independent history and physical, compromise their ability to establish a differential diagnosis and evaluate medical risk factors. Identifying other possible causes for a patient’s symptoms may result in the ordering of other diagnostic studies that help doctors hone in on the true cause.

Lack of communication among medical providers: The three doctors did not communicate about this patient’s care, no medical records were obtained and follow-up was not attempted. For a patient to receive the best care available, it has to be coordinated. It is especially important to make sure that the patient is following up on any recommendations (and, if not, why). Although counseling may be an appropriate part of the treatment plan, a clinical explanation should stay in the differential diagnosis until symptoms resolve.

No review of previous medical records: When a patient seeks care from numerous providers, it is often considered a red flag. For a patient who complains of worsening symptoms and who is not improving, a good course of action would be additional testing or referral to a specialist for evaluation.

For more on medical safety issues, see the library of articles by Daytona Beach medical malpractice attorney.

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