Anatomy of a Brain Injury Lawsuit: An MRI Scan of the Brain Was Misread by a Radiologist
That report was a misreading of what was on Sharon Burke’s brain scan. The July scan actually showed a blockage of one of the major blood vessels feeding the brain Ð the right internal carotid artery Ð and clear evidence of stroke damage in the parts of the brain fed by that artery. Sharon Burke went on to suffer a major stroke several months later, a stroke that could have been prevented if her scan in July 2000 had been read correctly and she had been put on blood-thinning medications to block the development of the clots that damaged her brain.
The incorrect brain scan report by Dr. William Higgins of Groover Christie misled both Dr. Stuart Goodman, Ms. Burke’s neurologist at the time of the scan, and another neurologist whom Ms. Burke’s family took her to in September 2000, frustrated by Dr. Goodman’s failure to figure out what was wrong with her. Both neurologists ordered a series of tests to chase down the possibility of multiple sclerosis and other diseases which Ms. Burke didn’t have. Ironically, the second neurologist looked at Ms. Burke’s brain scans himself just a few days before she suffered a major stroke and had scheduled her to have imaging of the blood vessels in the brain Ð but the orders came too late to get the tests done before her stroke.
On the morning of October 23, 2000, Ms. Burke’s mother found her in her bedroom, unable to speak or move. She was taken to a hospital, where imaging tests found the blood clots in her neck arteries and the arteries in the brain. But it was too late to prevent major brain damage.
After Ms. Burke had gone through months of rehabilitation, and she had recovered only a fraction of her pre-stroke abilities, her mother, Wilhelmina Torian, brought her to the lawyers at Patrick Malone & Associates seeking answers about whether the doctors had dropped the ball in their care. The lawyers obtained all the relevant medical records and copies of the two MRI scans done before the major stroke, as well as post-stroke brain imaging. These were organized and sent to independent experts in the fields of neuroradiology (radiology that focuses on the brain and spinal cord) and neurology. These experts reported back that both neurologists as well as the radiology group were negligent in their care of Ms. Burke and had caused her to suffer an unnecessary stroke.
Suit was filed late in 2001. Depositions were taken of both neurologists, the radiologists involved in the two pre-stroke scans, and expert witnesses hired by both sides. Because of various delays in the court system, the case did not reach trial until March 2004. Trial took place in the Superior Court of the District of Columbia, Judge Mary Terrell presiding.
Key evidence that Ms. Burke’s lawyers used to prove their case showed a portion of the brain’s blood supply, the carotid arteries leading up from the front of the neck and the cerebral arteries that flow from the carotids. The carotid artery makes an S-curve as it comes into the base of the brain. It was at this curved section that Ms. Burke’s carotid artery was shown to be blocked in the July 2000 scan.
Here is a chart comparing the December 1999 MRI scan to the July 2000 scan. These are both horizontal slices through the lower part of the brain. At the top of each scan, you can see the eyes and the nasal cavities. The boxed area just behind the nasal cavities is the spinal cord with a double-barreled cut through the carotid arteries on each side. On the December scan, the normal flowing blood vessel appears as two black holes on each side of the spinal cord. On the July scan, the right internal carotid artery now appears as two white holes instead of black.
This was never reported by the Groover Christie radiologist, who testified at trial that he did not do so because he thought it was an “artifact” and not a true blockage, and he didn’t want to confuse the neurologist. Ironically, he did confuse two separate neurologists, who both testified that the information about a blocked carotid artery would have completely changed their thinking about what was wrong with Ms. Burke. A blocked major vessel does not go with either multiple sclerosis or blood vessel inflammation, the other two alternate diagnoses being considered.
There were other reasons why the July 2000 MRI scan should have been reported as showing stroke and not other possibilities. This was illustrated by comparing textbook images of stroke and multiple sclerosis to what was seen in Ms. Burke’s brain on other images from the same scan (see image to the right).
The areas of white seen in the upper left (on the patient’s right side) in Ms. Burke’s images showed a wedge-shaped pattern (top image) and gyriform appearance (lower two images) Ð a curving snake-like pattern that means the surface of the brain’s cortex has been damaged. These are both indicative of stroke and are completely unlike the deep damage near the brain’s ventricles seen in multiple sclerosis.
Ms. Burke’s case against the radiology group was supported by the testimony of David Yousem, M.D., chief of neuroradiology at Johns Hopkins Hospital in Baltimore. Dr. Yousem testified that Dr. Higgins’ official report violated the “standard of care” for neuroradiologists in five distinct ways.
First, he failed to report a major abnormality, the blocked carotid artery. Second, Dr. Higgins gave in his official report a confusing list of three possible “differential diagnoses” for the abnormalities in Ms. Burke’s scan: multiple sclerosis, vasculitis (or arteritis) and ischemia, and he listed them in that order, leading both neurologists who ultimately relied on this report to the natural conclusion that multiple sclerosis was the most likely cause of the changes in her scan. Third, Dr. Higgins failed to compare this scan to her prior MRI scan from December 1999, which would have revealed that the blocked carotid artery was a new finding and thus no “artifact.” Fourth, Dr. Higgins failed to recommend follow-up studies to determine the significance of the blocked carotid artery. Fifth, Dr. Higgins failed to call the treating neurologist and alert him that the diagnosis had changed, from the “multiple sclerosis” that Goodman had put on the request slip for the MRI, to stroke caused by a blood clot in the right internal carotid artery.
Dr. Yousem’s testimony was backed by references to published standards then in effect from the American College of Radiology, the national professional society of radiologists. (Read the ACR 2000 standards for reporting diagnostic radiology findings by clicking here.)