Hemorrhagic Brain Injury Due to Negligent Treatment
Lawsuit Against University of Maryland Medical Center | August 3, 2020
On August 3, 2020, WVFK&N attorneys Keith Forman filed a medical malpractice claim on behalf of a woman who suffered severe brain hemorrhaging as a result of the negligent performance of the incorrect procedure to treat an aneurysm.
The complaint alleges that in November of 2017 the woman was admitted to the hospital for testing and evaluation after a seizure which lasted for several minutes and resulted in a loss of consciousness. On November 25, 2017, an MRI of her brain demonstrated a suspect berry aneurysm immediately superior to the origin of right middle cerebral artery (MCA). On December 28, 2017 an MRA of the brain confirmed the saccular aneurysm of the right MCA trifurcation, and also demonstrated a 7 to 8 millimeter saccular aneurysm of the right internal carotid artery terminus (R. ICA terminus). Neurosurgical evaluation was recommended at the University of Maryland Medical Center. On January 23, 2018, doctors performed a digital subtraction angiogram (DSA), which found multiple aneurysms in the right carotid system. All were described as “large, irregular and quite problematic.” A fourth aneurysm located in the area of the superior cerebellar artery was described as “smaller, rounded and least problematic.” The doctors agreed that the right MCA aneurysm would be very difficult to treat endovascularly and should be clipped, but “The rest can potentially be coiled or stented, although this presents a problem obviously because she has to be on aspirin and Plavix.” On February 6, 2018, a doctor performed a right pterional craniotomy with successful clipping of the right MCA aneurysm. The patient was scheduled for endovascular treatment of the right carotid terminus aneurysm to occur on June 5, 2018, with her understanding that a pipeline flow diversion stent was going to be used to bypass the area of the right carotid terminus aneurysm which would then result in the embolization or clotting-off of the aneurysm. This understanding was confirmed on May 21, 2018 at a pre-operative evaluation. On June 5, 2018, the patient arrived at University of Maryland Medical Center for the endovascular procedure to embolize her right carotid terminus aneurysm. The patient signed a consent form giving permission for a procedure described as a “Cerebral angiogram, coiling of the aneurysm, possible placement of a stent, possible balloon assistance…” The Consent incorrectly noted the site of the operation of the head and brain as being on the left. On review of the angiogram, at 11:24 a.m., the last coil was reported to be placed without incident. The procedure report states that “during the placement of the last coil, one of the coils are (sic) seen entering the laterally oriented daughter domes of the aneurysm.” Thereafter, the embolization microcatheter was removed. At 11:30 a.m. an angiogram was performed which demonstrated that intra-procedural rupture of the aneurysm had occurred resulting in intracranial bleeding, a surgical emergency. Contrary to the standard of care, the doctors failed to immediately perform procedures to treat the area of rupture and stop the bleeding. From 11:23 a.m. until sometime immediately prior to 12:23 p.m. no physical action was taken to stop the bleeding in the brain resulting in uncontrolled hemorrhaging. At 1:40 p.m., the neurosurgery team, who at some point had been called emergently, placed an external ventricular drain to control the increasing intracranial pressure. A CT performed at 2:38 p.m. demonstrated the severe extent of the hemorrhaging which had occurred. The patient was returned to the operating room at 4:00 p.m. on June 5, 2018, where a doctor performed an emergency right frontotemporal parietal decompressive craniectomy and duraplasty for “intractable intracranial pressure and intracerebral hemorrhage following aneurysm rupture” which was resulting in brain swelling. This would allow for the brain to expand extracranially without further compression from the skull. The skull flap from the right side of head was harvested and sent for tissue banking to be used to repair the defect in her skull once her brain decompressed. Immediately after the craniotomy was performed, a CT was performed at 8:14 p.m. When compared to the CT performed at 2:38, the radiologist noted an increase in size and volume of the previously seen hematoma within the brain tissue located in the frontotemporal and parietal lobes on the right. There was also worsening of the swelling with the ventricular system almost obliterated and worsening of the right to left midline shift. The woman was then taken to the intensive care unit where she remained intubated and on and off the ventilator for several weeks. She developed numerous neurological injuries including left sided paralysis, dysarthria, and severe cognitive and language dysfunction. She was discharged for traumatic brain injury rehabilitation on July 13, 2018 and is now in a long-term care facility. She remains paralyzed on her left side with continuing cognitive and speech problems.
The lawsuit alleges, among other things, that the defendants negligently responded to the rupture of the aneurysm which lead to the uncontrolled bleeding and subsequent hemorrhaging into the woman’s brain, and that this negligence ultimately caused the patient’s injuries.
The action is pending in the Circuit Court for Baltimore City, Maryland.