Case #1095: Aneurysm
On July 19, the Plaintiff’s Decedent presented to the Defendant internist with complaints of severe and sharp left eye pain, unremitting headache and dizziness. In fact, she had a history of the onset of left sharp eye pain and throbbing, frontal headache dating from July 1.
Upon examination, the Defendant internist found that the Decedent’s left pupil was 5 millimeters dilated and reacted sluggishly to light. The Plaintiff alleged that with a history of the onset of left and sharp eye pain with unremitting frontal headache, as well as the finding of a dilated and sluggish pupil, an aneurysm of the brain was required to be ruled out by angiography. Contrary to the standards of care, the Defendant ordered no angiography but instead, ordered a head CT, made a diagnosis of sinusitis, and referred the Decedent to an otolaryngologist.
On July 22, the Plaintiff’s Decedent was seen by the Defendant otolaryngologist who found that the Decedent had a severe left ptosis of the eye lid (drooping of the eye lid due to pressure on the cranial nerve). Additionally, he found the pupil to be dilated and sluggish, as well. Significantly, the Decedent did not have any fever, nasal discharge or other signs of acute sinusitis. Moreover, the head CT only showed old pathology on the right sinus with the Decedent’s symptoms appearing on the left side. Despite these signs and symptoms which were classic for an aneurysm of the left internal carotid artery, the Defendant ENT failed to order an angiogram and simply referred the Plaintiff’s Decedent to an ophthalmologist.
On July 23, the Defendant ophthalmologist saw the Plaintiff’s Decedent. At this time, the severe ptosis was present, the pupil was widely dilated, and the Plaintiff’s Decedent suffered with exotropia (the left eye was in a fixed, lateral gaze). Instead of ordering angiography, which was required by the standards of care, the Plaintiff’s Decedent was placed on steroids and was asked to return to see the Defendant ophthalmologist on July 26.
On July 26, the Plaintiff’s Decedent returned. At that time, the Defendant ophthalmologist confirmed the fact that the pupil was widely dilated, the exotropia continued with severe ptosis as well as the continuing headache throughout this period of time. The Defendant ophthalmologist finally agreed that angiography was necessary but negligently failed to order the test on a stat or emergency basis. Instead, he scheduled the study for the following week and permitted the Plaintiff’s Decedent to return to her home.
On July 27, the aneurysm located in the Plaintiff’s Decedent’s brain exploded, causing a massive subarachnoid hemorrhage. As a result, she was transported to the Southern Maryland Hospital and subsequently transferred to the Georgetown University Medical Center for emergency surgery. Tragically, intervention at that point was too little — too late. The Decedent had already suffered massive brain injury and subsequently died on July 29.
The Plaintiff alleged that a Berry aneurysm involved the internal carotid artery on the left side of her brain, which expanded because the walls of the vessel had been weakened. Over time, the vessel continued to expand placing pressure on the ocular nerve, which caused the precise and classic presentation referred to above. Since the Defendants continually failed to order the angiography which would have confirmed the diagnosis, no surgical intervention was provided to the Decedent, and the vessel was simply permitted to expand over time and then burst, causing irreversible brain injury and her ultimate death. Based upon the location of the aneurysm on autopsy, surgery would have carried a greater than 98% chance of a successful outcome. At the time of her death, the Decedent was a 52 year old, employed by the United States Postal Service, and had three adult children.