Case #4057 Misdiagnosis Resulting in Paralysis
Plaintiff was 61 years of age at the time of this medical occurrence. His medical history was notable for hypertension, hyperlipidemia, diabetes and bipolar disorder. His surgical history included lumbar surgery in the 1980s, lumbar surgery at L4/5 in 2006, as well as epidural infections from 2007 and 2008.
On September 7, 2016, Plaintiff presented to the Defendant Hospital with left lower quadrant abdominal pain for the prior week. His vitals were as follows: T 37.1, Pulse 103, RR 20, O2Sat 95, BP 178/99. On exam, he was noted to have no neuro symptoms, with equal extremity movement, a steady gait, and a Glasgow coma score of 15. He underwent a CT scan which was reported as showing a moderate to large amount of colonic stool suggestive of constipation. Differential diagnosis included abdominal pain, appendicitis, bowel obstruction, renal stone, ureteral stone, pancreatitis and constipation. He was given morphine and Zofan, and he was discharged to home to follow up with a gastroenterologist.
Days later, Plaintiff returned to the Defendant Hospital after having multiple falls at home associated with syncope and bilateral lower extremity weakness. He was admitted. It was noted that he had syncope after micturitions. On neuro exam, he was noted to have motor strength of 5/5 in the upper extremities and 4/5 in the lower extremities. His tone was quite diminished in the lower extremities without sensory changes. Knee reflexes and ankle reflexes were also diminished. Assessment was generalized weakness most likely due to dehydration and hyponatremia. Syncope was most likely micturition syncope. He had hypertensive urgency and hyponatremia. With respect to his lower extremity weakness, it was noted that since he had a history of back surgery, he may need an MRI of lumbar spine in next 24 hours if there was no improvement with treatment for dehydration and hyponatremia.
Plaintiff therefore underwent an MRI of the lumbar spine, which showed multilevel mild degenerative changes are appreciated of the lumbar spine, most prominent at the L4-L5 level where there is minimal anterolisthesis of L4 with respect to L5 and bilateral facet arthropathy. There was only mild canal or foraminal narrowing appreciated throughout the study.
Later that evening, Plaintiff was evaluated by a neurologist who, upon evaluating the patient, ordered a stat MRI of the thoracic spine. The images noted a lesion in the thoracic cord at the level of his sensory level. Once all the images were available for remote viewing, the on-call neurosurgeon was contacted. Impression was epidural abscess.
Plaintiff was subsequently transferred to another hospital and diagnosed with spinal cord compression injury secondary to epidural abscess. He was brought into the OR for performance of an emergent T8, 9, 10 and 11 posterior thoracic laminectomy for epidural abscess. He was placed on Vancomycin and Aztreonam. He was discharged to home months later.
Despite the above-referenced interventions, Plaintiff is paralyzed and wheelchair bound.