Common Neurologic Misses in Emergency Rooms
ATLANTIC CITY — The patient had visited three hospitals, complaining of back pain. He was on narcotic medications, such as Percocet, and asking for more painkillers on his fourth hospital visit. One nurse noticed the patient’s unsteady gait. The staff of one emergency department soon dismissed the patient as a drug-seeker.
Dr. Michael D’Ambrosio, director, Capital Health’s Center for Neurologic Emergency Medicine, hears stories like this when he testifies as an expert witness about neurologic emergency medicine misses and misdiagnoses.
In the case of the back patient, the patient’s pain was real — and caused by a spinal epidural abscess that went undiagnosed by more than a half dozen emergency room physicians.
Dr. D’Ambrosio described the case in his presentation, “Common Neurologic Misses in the Emergency Room” at the 5th Capital Institute for Neurosciences Conference today at Atlantic City’s Revel hotel. The stakes of a missed neurologic emergency are high, Dr. D’Ambrosio said. The patient with the spinal abscess, for instance, became permanently paralyzed.
“It was a classic neurologic miss,” said Dr. D’Ambrosio, who is one of the few physicians in the nation board certified in neurology, vascular neurology and emergency medicine.
D’Ambrosio said another common miss is posterior circulation stroke. In fact, seven out of eight strokes that are missed in emergency rooms are posterior circulation stroke. A sign is vertigo. Other symptoms include neck pain, visual disturbances and a burning sensation in the chest or face. Dr. D’Ambrosio described the case of a 64-year-old woman whose stroke was missed.
Emergency departments are busy and pressure-filled. Dr. D’Ambrosio said physicians nonetheless must put aside their own biases, explore all options and closely examine and question the patient and follow the symptoms. Neurologic disorders often are diagnosed by careful consideration of the symptoms and simple exams, such as a visual exam or asking the patient to walk across the room.
“The average emergency room physician gets very little training in neurology," Dr. D’ Ambrosio said. “We need to provide greater neurology training for our emergency room physicians."
Capital Health offers a specialized neurologic emergency room at its Regional Medical Center, the first and only one in the country.