Missed Or Delayed Stroke Diagnosis: Legal Options And Why Early Treatment Matters

What is a missed or delayed stroke diagnosis?

A missed or delayed stroke diagnosis can have serious adverse effects, including brain damage, paralysis, permanent disabilities, and even death. Because of these serious adverse effects, it is important for stroke to be considered and ruled out when a patient reports relevant complaints.

Missed or delayed stroke diagnoses, including Transient Ischemic Attack (TIA), or "mini-stroke" can occur because the reported complaints are mistaken for other conditions such as:

• headaches;
• dizziness;
• intoxication;
• anxiety;
• vertigo; or
• other mental health conditions.

This misdiagnosis or failure to consider stroke in the differential diagnosis and to "rule out" stroke, can often occur in the emergency department. It can lead to the failure to perform a proper neurological examination or order the appropriate radiological imaging (such as a CT or CTA), which may have led to a proper stroke diagnosis.

There are also occasions when the proper radiological imaging is ordered, but the radiologist misinterprets the images, fails to report the existence of the stroke, and as a result the stroke diagnosis is missed or delayed.

Does earlier stroke diagnosis result in better outcomes?

While the saying is that "time is brain²" – the classic lawyer answer is "it depends". Earlier stroke treatment can result in a better outcome, but it is important to note that not all strokes are equal, and not all impairments from strokes can be prevented with earlier diagnosis or treatment.

Ischemic strokes

Some strokes, known as ischemic strokes (strokes caused by blood clots), have a better prognosis if diagnosed early due to a variety of treatment options. These treatments include:

• tPa, the "clot-busting" medicine, if the stroke is diagnosed within 4.5 hours³ from symptom onset;
• Endovascular therapy "EVT", which surgically removes the clot, if the stroke is diagnosed within 6 to 24 hours⁴ (typically 6 hours but can be extended to 24 hours depending on imaging/perfusion studies); and,
• Antiplatelet therapy⁵ such as aspirin/clopidogrel, if the stroke is diagnosed within 12-24 hours.

Ischemic strokes often have significantly improved prognoses and clinical outcomes if treatment is undergone with 4.5 hours from symptoms onset (for tPA) or 6 hours (for EVT).

Hemorrhagic strokes

Hemorrhagic strokes, often referred to as brain bleeds, have less treatment options, and less favourable outcomes⁶. Treatments for a hemorrhagic stroke focus on limiting the extent of the bleed and often cannot reverse damage that is caused once bleeding occurs. These treatments include⁷:

• blood pressure management;
• reversing any anticoagulation and craniotomy (if there is a pressure increase/brain shift); and/or,
• surgical treatment if there is an aneurysm or AVM present (including endovascular coiling, surgical clipping, or AVM resection/embolization if appropriate).

Patient-specific factors

There are also patient-specific factors⁸ that can influence stroke outcomes, including patient age, whether there is a pre-stroke disability, and whether there are other serious comorbid conditions.

Whether an earlier diagnosis would have resulted in a better outcome will be extremely fact specific. If you or a loved one have experienced a delay in stroke diagnosis, or a misdiagnosis, reach out to a lawyer with experience in stroke cases to discuss the facts of your specific case.

Should I contact a lawyer about my missed or delayed stroke diagnoses?

If you believe that you or a loved one has suffered from a missed or delayed stroke diagnosis, please contact our office for a free initial consultation. In order to be successful in a missed or delayed stroke diagnosis lawsuit, you need to prove that there was a breach of the standard of care that, on the balance of probabilities, caused injury or harm. These are complex legal and medical issues and require expert consideration. Our team has experience in investigating and litigating missed/delayed stroke diagnosis lawsuits in Ontario⁹.

Time limits for filing a medical malpractice claim

In Ontario, there is typically a two-year limitation period for medical malpractice actions. However, this period can vary depending on the specific circumstances of each case, including when you knew, or ought to have known, the facts giving rise to your case. Special limitation periods may apply for cases involving deceased individuals, minor children, or those under legal disability.

If the limitation period expires, you may be barred from initiating a medical malpractice action. If you are considering pursuing a claim for medical negligence, it is important to consult with a lawyer promptly to ensure that you do not miss the limitation period.

Siskinds' Medical Malpractice Lawyers

At Siskinds LLP, we have a team of lawyers and staff with expertise in medical negligence cases and health law, with extensive experience in assessing and litigating complex medical negligence cases, including missed and delayed stroke diagnoses.

Footnotes

1 2014 ONSC 1130 (CanLII) | Boyd et al. v. Edington et al. | CanLII

2 Time Is Brain—Quantified | Stroke

3 Efficacy and safety of tissue plasminogen activator 3 to 4.5 hours after acute ischemic stroke: a meta-analysis – PMC

4 Endovascular Therapy for Acute Stroke: New Evidence and Indications – PMC

5 6. Antiplatelet Therapy for Ischemic Stroke and Transient Ischemic Attack | Canadian Stroke Best Practices

6 Comparison between Ischemic and Hemorrhagic Strokes in Functional Outcome at Discharge from an Intensive Rehabilitation Hospital – PMC

7 Stroke – Diagnosis and treatment – Mayo Clinic

8 Stroke – Causes and Risk Factors | NHLBI, NIH

9 2014 ONSC 1130 (CanLII) | Boyd et al. v. Edington et al. | CanLII

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.