Text here: https://expertwitness.substack.com/p/missed-vertebral-artery-dissection
tl;dr
22-year-old man wakes up with left side weakness and dizziness.
Calls PCP, they get him in later that day.
Symptoms were mostly resolved so NP orders labs and sends him back home.
Next morning has worsening symptoms including left side weakness, left side sensory deficits, discoordination, visual deficits.
Goes to the ED, diagnosed with vert dissection and stroke.
Weird thing to me is that the patient is reported to have all left side symptoms, but left side parietal, occipital, cerebellar stroke. I suppose ataxia could be misinterpreted as weakness (makes sense that left cerebellar stroke would cause left ataxia), but left-side sensory symptoms are harder to explain. There was also confusion about visual field issues… I suspect he truly had right visual field deficit in both eyes despite how it was described in the lawsuit.
This may be an unpopular opinion, but I think a lot of doctors would have done the same thing as the NP. The patients symptoms had resolved and he was only 22 years old. This presentation is really unlikely to be a stroke. But sometimes it is! The history of weightlifting the day before probably raises the risk but I don’t think that’s a standard part of the history for people with dizziness.