Every Second Counts : The High Stakes of Timely Intervention in Paediatric Meningitis

Introduction

A four-year-old child’s life changed dramatically when the physicians disregarded the child’s week-long symptoms of headache, dizziness, and ear pain, failing to order the appropriate diagnostic tests and denying access to higher levels of care.

Client Requirements

A leading law firm in Wisconsin needed to establish that improper evaluation led to a misdiagnosis of bacterial meningitis in a four-year-old child. This misdiagnosis would support the argument that the disease had progressed to intracranial brain abscesses, dural venous thrombosis, and stroke.

Our Approach

We provided a medical chronology with a detailed timeline of events, and a case overview highlighting key points to unravel the medical negligence. We addressed all client-specific questions to enhance clarity and strengthen the claim. Additionally, we conducted an extensive literature review and provided referenced research articles to support our conclusions.

We emphasized the following facts to establish negligence:

Identifying the Etiology of Symptoms

• The child presented with persistent headaches, generalized weakness, dizziness, ataxia, and poor appetite. Unfortunately, meningitis was not suspected, despite the clinical presentation,

  chronicity of the symptoms, and the child’s unvaccinated status. Deliberately, the child was discharged with a recommendation to follow up in two days.

Reasons for Misdiagnosis of Meningitis:

• There was a failure to obtain an MRI or a CT with contrast of the brain. Although a CT of the head was performed later, it was without contrast, limiting diagnostic accuracy.

• The clinical course raised concerns about infectious pathology, including subacute bacteremia. However, the condition was correlated to complicated, partially treated otitis media rather than meningitis. Although pediatricians recommended an MRI, the treating physicians did not perform it until the child’s condition deteriorated, leading to altered mental status and left-sided deficits.

Consequences of Delayed Diagnosis:

• By the time the MRI was obtained, the child’s condition had progressed to brain abscesses, hydrocephalus, and extensive dural venous thrombosis.

• Unfortunately, the ear pain and fever, consistent with acute otitis media, complicated into acute mastoiditis, which progressed to acute meningoencephalitis and intracranial brain abscesses.

• This, in turn, was complicated by multiple infarctions, resulting in delirium, neurostorming, and agitation.

Conclusion

The child’s acute otitis media, complicated by mastoiditis, progressed to acute meningoencephalitis, brain abscesses, dural venous thrombosis, and multiple infarctions, causing delirium, neurostorming, and agitation. The stroke was a sequela of meningitis that could have been prevented with an earlier diagnosis. The prolonged and recurrent left-sided otitis media and mastoiditis were likely primary contributors to the thrombotic risk, causing dural sinus venous thrombosis involving the left sigmoid and transverse sinuses. Due to the irreversible neuronal damage that occurs during bacterial meningitis, there is a significant risk of developing long-term cognitive deficits and learning difficulties.

Case Resolution

By offering a detailed medical chronology, and expert opinion with a summary of merit, we helped the law firm in Wisconsin in building a well-organized and compelling case based on the extent of the child’s and the family’s suffering.