Imagine you are going about your day when suddenly you notice
something just isn’t feeling quite right. Perhaps there’s
some weakness in your arm. Maybe you’re having some difficulty
speaking. Or you suddenly have a terrible and unusual headache.
Then a terrible thought crosses your mind. Could this be a
Immediately you run through the B.E. F.A.S.T. checklist to
determine if you have stroke symptoms:
B – Balance: Loss of balance or coordination and dizziness.
E – Eyes: Trouble seeing out of one or both eyes.
F – Face: Droopy facial features, uneven smile or facial muscle
A – Arm: Inability to raise arms evenly or weakness
S – Speech: Difficulty repeating simple phrases or impaired or
T – Time: You must seek medical attention immediately by calling
Recognizing symptoms associated with a stroke and quickly
receiving medical attention could not only minimize the damage this
affliction causes, but it might also just save your life. A delay
in treatment, including misdiagnosis, could result in life-long
disability or death.
In this blog, I outline the types of strokes, explain why there
is such a high rate of misdiagnosis, note how misdiagnosis often
results in poor outcomes for patients, and examine how misdiagnosis
may qualify as medical malpractice.
Types Of Strokes, Symptoms, Misdiagnosis
Strokes occur when there is a disruption of blood to the brain.
Without blood flow to provide oxygen and nutrients to the brain,
cell damage and cell death begin to occur in the brain area that is
There are two major types of strokes. Ischemic strokes, which
occur in about 80-90 percent of cases, are caused by a blood clot
that blocks or restricts blood vessels or arteries in the brain. A
hemorrhagic stroke, which occurs in about 10-20 percent of cases,
occurs when a blood vessel in the brain breaks and blood is
In addition to the B.E. F.A.S.T. checklist, strokes symptoms can
include sudden headache, vertigo, nausea, and confusion.
Unfortunately, these kinds of signs are not unique to strokes, and
misdiagnosis is common. For example, nonvascular diseases such as
epilepsy, multiple sclerosis and hypoglycemia are called
“stroke mimics” because patients present with stroke-like
According to a major 2017 study of American patients
presenting stroke symptoms at emergency departments, almost one in
10 suffered initial misdiagnosis. When the study looked at mild
stroke symptoms or transient symptoms, the misdiagnosis rate
reached 24 to 60 percent. Studies have found that stroke victims
presenting with FAST symptoms, particularly hemiparesis and
dysarthria, were more likely to be diagnosed accurately than
patients with transient or resolved symptoms, altered mental
status, nausea or vomiting, and dizziness and vertigo.
If a physician misdiagnoses an atypical stroke, it is
unfortunate but not always legally actionable. If a physician did
an adequate general and neurological assessment and gave
appropriate instructions to the patient, failing to associate
atypical symptoms with the possibility of a stroke would likely not
be considered medical malpractice.
However, if the physician did not take steps to make a proper
assessment or standards of care were otherwise breached, the
resulting misdiagnosis could be medical malpractice.
For example, when peer experts reviewed the C.M.P.A.’s medical-legal stroke misdiagnosis
cases, they were critical of fellow doctors:
– failed to recognize the severity of a patient’s
symptoms when there were red flags, including new or severe
headache or focal neurological signs
– failed to perform complete physical and neurological
examinations, visual field assessments and motor and sensory tests
– developed an inadequate alternate diagnosis or anchored
on such a diagnosis to the extent that impeded correct final
diagnosis of a stroke
– failed to repeat neurological examinations if a
patient’s condition remained unchanged or
– relied too heavily on the sensitivity of C.T. scans to
Particular criticism was also reserved for doctors who failed to
consider a stroke diagnosis in patients with distinct risk factors
(smoking, obesity, hypertension) or who had a history of
The C.M.P.A. review also noted that insistences of misdiagnosis
often involved not following appropriate clinical guidelines,
delayed reporting or delayed contact with a treating physician with
test results, communication problems between medical providers, and
unavailability of testing equipment.
Misdiagnosing a stroke patient in the first few hours after they
present with symptoms can have a devastating impact on their
outcome. If a patient has suffered from the most common type of
stroke – the ischemic stroke – they can be treated with t-PA, a
medication that dissolves blood clots – but only within a short
window of time. Research has shown that ischemic stroke patients
who received this course of treatment within three hours of the
onset of symptoms were at least 30 percent more likely to recover
with little or no disability after three months. However, even if
the patient first presents outside of this window, an initial
misdiagnosis can still result in unnecessary delays in treatment
and increase the risk and extent of permanent damage.
Help Is Available
Suppose the misdiagnosis or delayed diagnosis of a stroke has
caused you or a loved one disability. In that case, it may be worth
your time and effort to review your medical records with a personal
injury lawyer to determine if your medical providers offered
improper, unskilled or negligent care.
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.