Acute Ischemic Stroke

Medical Literature: Bolster Expert Opinion

Medical literature often plays an important role in medical negligence cases and can be persuasive for both the standard of care and causation analysis.

If there are relevant recognized practice guidelines published by professional organizations, in peer-reviewed journals, or in textbooks, these can be useful to bolster the standard of care case. In Hasan, the plaintiff’s standard of care expert, Dr. Brankston, gave evidence on the appropriate approach to evaluating a patient with vertigo and other cranial nerve abnormalities. The court noted that the approach he described lined up with the guidance provided in a particular textbook.15 It was especially helpful that the textbook was one accepted by the defendant and other expert physicians as an authoritative text and reference guide.

This alignment of the plaintiff’s expert’s opinion with the guidance provided by this accepted textbook not only gave added weight to the opinion, but also undermined the defence’s urging that the expert’s opinion should be rejected on the basis that he was not impartial, that he was biased and that his opinion was arrived at through the benefit of hindsight.16

Medical Literature – Distinguish Your Client

It was nearly 30 years ago that the phrase “time is brain” was coined to recognize the importance of early treatment to improve the chance of recovery from stroke. In those early days of ischemic stroke therapy using tPA to dissolve the clot, the time window for the successful treatment was considered to be three hours from the onset of symptoms. Over the years that window has been extended up to four-and-a-half hours. More recently, head imaging has been used to identify certain patterns of ischemia that are associated with a greater chance of neurological improvement even if reperfusion occurs more than 12 hours after the onset of symptoms. In addition, the literature has shown that optimal collateral circulation can positively affect outcomes, and that the location of the clot may also be relevant to the chance of successful recovery.17 This information highlights the importance of ensuring that your experts consider the unique characteristics of your client and are prepared to distinguish them from the participants in studies that report aggregated data.

Mr. Hasan had very good collateral circulation, as mentioned earlier. Unfortunately for another plaintiff, Ms. Neelands, she did not. Although her case bears similarity to that of Mr. Hasan — minor symptoms culminating in a significant stroke — Ms. Neelands’ lack of good collateral circulation contributed to the finding that earlier treatment would not have been of benefit to her.

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Brenda Osmond


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