In the fall of 2013, a 38-year-old woman who had recently given birth to her first child attended hospital, complaining of edema (swelling) of her extremities, shortness of breath, epigastric pain, and chest pain. She had a chest x-ray and was prescribed Azithromycin (an antibiotic medication used for the treatment of a number of bacterial infections) before being discharged.
A few days later, she returned to the presented to the Emergency Department as the symptoms persisted. She complained of severe headaches and neck pain. She had hypertension (high blood pressure) and her blood pressure varied throughout the evening, ranging from the 130s to the 170s. Her blood pressure was recorded at 161/74 and her urinalysis revealed Proteinuria (elevated levels of protein in urine). She also had Bradycardia, which is a significantly slow heart rate.
The woman was discharged with a prescription for Labetalol (an antihypertensive) and opiates for pain control. The doctors, Dr. A and Dr. B failed to meet the standard of care by not considering a potential cardiac cause to her symptoms and not ordering an echocardiogram, despite one being warranted in the circumstances.
Two days after being discharged, the woman was found unresponsive at home and subsequently diagnosed with an intracranial (within the skull) bleed secondary to Eclampsia (onset of seizures or coma in women with Pre-eclampsia. Pre-eclampsia is a serious medical condition where people experience high blood pressure, protein in their urine, swelling, headaches and blurred vision). A CT scan revealed that she had suffered Fibromuscular Dysplasia (FMD). FMD is a condition that causes narrowing (stenosis) and enlargement (aneurysm) of the medium-sized arteries in your body. Narrowed arteries can reduce blood flow and affect the function of your brain. FMD may lead to life-threatening hemorrhage/stroke.
Later that day, the woman was transferred to the operating room for a left frontal craniotomy and clot evacuation. She survived the hemorrhage but has been left with significant neurological deficits, including global aphasia (damage to the parts of your brain that control language). She is also dependent on a wheelchair and due to her swallowing difficulties, requires a feeding tube.
The woman worked full-time prior to her stroke. Her husband was forced to take time off work following his wife’s stroke, and care for his newborn child and wife in hospital on a daily basis. The woman is no longer able to engage in her pre-stroke activities and relies on her husband’s care in all aspects of daily living and personal care.
Had her hypertension been appropriately and aggressively managed prior to her hospital visits, her intracranial hemorrhage (stroke) and associated neurological conditions would most likely have been prevented. Her hypertension necessitated admission to hospital and treatment as she had the criteria to meet the definition of severe Pre-eclampsia. The doctors’ missed numerous opportunities to admit her to hospital, which more likely than not caused the cerebral hemorrhage that she experienced, and with it, her subsequent neurological impairments.