Introduction This case study explores the delay in the diagnosis and treatment of the spinal hematoma that resulted in acute plegia, neurogenic bladder, and other functional impairments in a patient who presented with excruciating abdominal and back pain. What They Needed A leading law firm in Michigan sought to investigate whether there were any delays in the diagnosis and treatment of celiac artery dissection or spinal cord hemorrhage, which resulted in paralysis and chronic pain in the patient. How We Did It Medical Background The patient had a medical history significant for osteoarthritis, rheumatoid arthritis, varicose veins in bilateral lower extremities, and paroxysmal atrial fibrillation requiring anticoagulation (Xarelto). Recently, the patient was diagnosed with COVID-19 and a urinary tract infection with ongoing antibiotic treatment. Correlation of Symptoms and Signs with Medical History Symptoms of a spinal subdural or epidural hematoma begin with severe local or radicular back pain and percussion tenderness. The patient presented with severe abdominal pain radiating to the mid back, along with nausea. A detailed examination revealed epigastric tenderness and soft lower extremity compartments. Diagnostic Studies to Rule Out Differential Diagnosis A CT of the abdomen and pelvis and a CT angiogram of the chest, abdomen, and pelvis were performed to determine the etiology of the sudden onset of abdominal pain. The results suggested a possible celiac artery dissection with extension into the hepatic artery. Therefore, differential diagnoses for back pain were not considered at that point, as their primary focus was abdominal pain. Diagnosis and Treatment Plan The vascular surgeon recommended starting Aspirin and Lipitor due to low concern for true dissection based on the overall presentation. Xarelto was discontinued, and the patient was eventually started on Heparin infusion, Aspirin, and Statin therapy. Complications Despite the above-mentioned treatments, the patient developed an acute onset of bilateral lower extremity weakness with urinary retention and bilateral hip pain. The Results Upon reviewing the medical facts, we found out that there was a failure to diagnose the spinal subdural hematoma, despite the clinical presentation of persistent abdominal pain, bilateral back/hip pain, and lower extremity pain/swelling. The abdominal pain was misattributed to celiac artery dissection rather than being recognized as referred superficial abdominal wall pain related to thoracic radiculopathy (T5-T9), which supplies nerves to the chest, back, and abdomen. Consequently, early neurology consultation and appropriate imaging studies (such as MRI of the thoracic and lumbar spine) were not pursued. In addition, the initiation of Heparin and Aspirin therapy exacerbated the underlying spinal hemorrhage. Given the low concern for true dissection, as indicated by the vascular surgeon, it was critical to rule out the underlying cause of the back pain. The presentation of mesenteric dissection was atypical, characterized by diffuse upper abdominal pain not related to food ingestion, accompanied by frequent nausea and emesis. Ultimately, the failure to diagnose the spinal subdural hematoma, beginning at the T5-T6 level, delayed necessary surgical intervention. This oversight resulted in progressive bilateral lower extremity weakness, associated numbness, neurogenic bladder, and acute plegia due to spinal hematoma with thecal sac compression. Our medical chronology, combined with expert opinion, helped the law firm in Michigan uncover the mystery behind the case, demonstrating that the injuries were a result of medical negligence.

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.