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Stroke

Medico-legal review suggests that physicians miss the signs of stroke

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A recent review of cases conducted by the Canadian Medical Protective Association, an organization that defends physicians in Canada, has found that most medical malpractice cases involving stroke had issues with the diagnosis. This means that sometimes doctors are missing the signs of stroke at initial presentation thereby depriving patients of necessary prompt treatment. In the cases reviewed, more than 25% of patients died and another 40% were left with a significant disability.

In the reviewed cases, the common stroke symptoms were headache, dizziness, nausea and vomiting. Delayed presentation with longer symptom duration spanning days and sometimes weeks was also seen. We can take it from the CMPA synopsis that cases where there was atypical presentation of stroke were generally easier to defend, especially where there was adequate neurological assessment and where appropriate discharge instructions were provided to a patient.

  • Malpractice cases that were more successful included situations where physicians
  • Failed to recognize the seriousness of the patient’s condition with red flags such as a new or severe headache, or focal neurological signs,
  • Did not perform a full physical examination including full vital signs, orientation, gait, speech, finger-to-nose testing, and visual field assessment, examination of the cranial nerves and motor and sensory function in all four extremities,
  • Developed an inadequate differential diagnosis,
  • Failed to consider the possibility of stroke in patients who have obvious risk factors such as smoking, obesity and hypertension,
  • Anchored on a specific diagnosis such as migraine or psychiatric disorder without considering the possibility of stroke.

Research suggests that up to 10% of strokes are not recognized at initial presentation. Research also shows that earlier diagnosis and treatment of stroke can improve outcomes. If you or your loved one suffered an injury as a result of a stroke and you were seen at the hospital or at a medical clinic and you believe that the diagnosis was potentially missed or delayed, you may be entitled to compensation for the injuries. At Pacific Medical Law we often hear from patients who have experienced a misdiagnosis or delayed diagnosis of stroke that left them with a permanent disability. Although it is not possible to identify negligence in every case we review, we have been successful at helping clients obtain much-needed compensation for the injuries that they suffered as a result of a missed or delayed diagnosis of stroke.

You can read more about the CMPA case review findings here: https://www.cmpa-acpm.ca/-/stroke-can-you-recognize-the-signs-

Stroke Ambulances – The Future Standard in Stroke Care?

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Canada’s first trial of an advanced Stroke Ambulance in Edmonton could signal a new era of significantly improved standard of care of ambulance-level stroke care in this country. Equipped with a mobile CT scanner and an internet link to the on-call neurologist in the hospital, the new stroke ambulance has the potential to dramatically improve patient outcomes and could become the new standard of care of emergency ambulance response to a call where symptoms reported could be those of a stroke. Why are we so excited about Canada’s first highly-specialized Stroke Ambulance and why do we believe that other health jurisdictions in the country should follow?

What is a Stroke?

A stroke occurs when blood flow to the brain is cut off, leading to the death of the affected brain cells. While all strokes are serious matters, they do not all result in debilitating injuries. If identified and dealt with promptly, a stroke can often be contained to only have mild consequences. Doctors estimate that over 100 million brain cells die each hour, so rapid diagnosis and treatment is critical to a patient’s chances of making a successful recovery.

To understand why they say, “time is brain”, it is important to understand that strokes arise from two primary causes, and are classified and treated accordingly:

  1. ischemic strokes are caused by a blood clot restricting blood flow in the brain,
  2. hemorrhagic strokes are caused by a burst blood vessel causing uncontrolled bleeding in the brain.

According to the Canada Heart and Stroke Foundation, ischemic strokes make up approximately 80% of cases, and hemorrhagic strokes make up the remaining 20%. The fundamental difference between the causes of the two types of stroke results in completely different treatment protocols. For example, patients suffering ischemic strokes are commonly administered medication known as tPAs (tissue plasminogen activators) that actively break down blood clots, and the sooner they can be administered the better the chances are of recovery. Importantly, the patient must receive these tPAs within the first three hours of the onset of the stroke symptoms for medication to have any meaningful effect. The tricky issue in the timing is that before the treatment can be administered, it is necessary to determine the type of stroke a person is suffering. If tPAs are administered to a person suffering a hemorrhagic stroke, the medication can exacerbate the already damaging bleeding going on in the brain and can lead to devastating consequences.

With the key technological developments in the Stroke Ambulance of an in-ambulance mobile CT scan and an internet link radiologist and neurologist, the CT scan can be conducted on the spot and immediately sent for review by an expert radiologist, identifying the type of stroke far sooner than possible before. In approximately four out of five cases, it will be the more common ischemic stroke, allowing the vital tPAs to be administered much sooner, potentially by hours for rural patients. This can be the difference between a mild or serious stroke, a short or lengthy recovery, and a small or significant cost to the health care system.

BC Brain Injury Association – Improving the lives of people living with brain injuries

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It is estimated that 50,000 Canadians suffer a traumatic brain injury each year – and the majority of these are young adults.

At Pacific Medical Law, we can assist people who have suffered as a result of a delayed diagnosis of a traumatic brain injury or a failure by a physician or other health care professional to diagnose an underlying medical condition such as an impending stroke.

Traumatic brain injury is the leading killer and disabler of Canadians under 40 years of age. Thanks to medical advances many people who would once have died from their injuries are able to survive; however, these individuals will require lifelong care because of the cognitive impairments and emotional effects of their injuries.

The BC Brain Injury Association (BCBIA) is a non-profit organization established in 1982 to serve the interests of people living with acquired brain injuries. Founded on the belief that every person with an acquired brain injury has the right to be considered as a full participating and impactful member of society, BCBIA’s mission is to be a leader in improving the lives of people who live with acquired brain injury in BC. Brainstreams.ca, the organization’s official website, provides continual access to information and support resources for the thousands of individuals in BC and beyond who experience brain injury each year. Visitors can also find news on medical breakthroughs, inspirational stories from survivors of brain injury, and upcoming events in the community.

For those interested in supporting this important cause, the BCBIA hosts an annual Cocktail Gala to help improve the lives of people living with acquired brain injuries by raising funds and awareness. This year’s Gala will take place on Thursday, February 5, 2015, and will feature mental health advocate Margaret Trudeau and brain injury awareness advocate Ellie Ennis as guest speakers. Tickets and more information are available at brainstreams.ca.

New Poll Reveals Misconceptions about Stroke among Canadians

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A report released by the Heart and Stroke Foundation of Canada suggests that Canadians have plenty of misconceptions about stroke, and what it takes to recover from one. The poll conducted by the HSFC found that half of all Canadians have a close family member or a friend who has had a stroke and that many of these people do not realize that it may take weeks or months to recover from one.

Dr. Sean Dukelow, a researcher at the Hotchkiss Brain Institute at the University of Calgary, was surprised that one in five Canadians thinks a stroke is always fatal, when in fact only 10 percent of people die from it. Most stroke victims live; however, the recovery may sometimes takes weeks, months or even years.

Similarly, less than two-thirds of Canadians know that most strokes can be prevented. Also, almost one in six believes once a person has recovered from a stroke there is nothing they can do to prevent another one. The fact is up to 80 per cent of premature heart disease and strokes can be prevented by managing risk factors.

The poll also reveals that more than one-third of Canadians believe that the recovery period of a stroke is limited to a few months. The truth is that recovery can last a life time in some cases. Dr. Dukelow points out that a stroke affects more than just the patient, but also their family and friends. “Without supportive family, some of the patients that I see end up in a nursing home or a long-term care setting because they don’t have a family who can support them through the process,” he says.

According to the Heart and Stroke Foundation, stroke is the third leading cause of death in Canada. Every ten minutes a Canadian suffers a stroke, and as the population continues to age these numbers are bound to increase. The results of this poll suggest that Canadians need more education and increased awareness about stroke and its effects.

Read the Heart and Stroke Foundation 2013 Report here:

Read the news article here

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