Urgent Care Stroke & Subarachnoid Hemorrhage Expert Witness
Analyzing Missed Aneurysms and "Thunderclap" Headaches
The Most Dangerous "Miss" in Headache Cases
Headache is a common complaint in Urgent Care, often caused by benign issues like sinusitis, tension, or migraine. However, the most dangerous "miss" in this category is the Subarachnoid Hemorrhage (SAH), a bleeding aneurysm that can present as a sudden, severe headache.
Because Urgent Care centers lack CT scanners to visualize bleeding in the brain, the Standard of Care relies entirely on the provider's history-taking and neurologic physical exam. When these are skipped or documented poorly, the results can be fatal.
Dr. Max Lebow provides specialized expert review to determine if a provider missed the clear "red flags" of a neurologic emergency or if the presentation was truly non-specific.
The "Thunderclap" Warning
The classic presentation of a subarachnoid hemorrhage is the "thunderclap headache", described as the "worst headache of my life" reaching peak intensity instantly.
In an Urgent Care setting, the Standard of Care requires the provider to specifically rule out this history.
Did the provider ask about the onset of the pain?
Sudden vs. Gradual onset is critical for identifying thunderclap headache
Was a neurologic exam performed and documented?
Every headache must have a neurologic exam evaluated and documented
Were cranial nerves, gait, and pupil response checked?
Simple checks that can identify signs of neurologic emergency
The Neurologic Exam Requirement
"Every headache must have a neurologic exam evaluated and documented."
Failure to document simple checks like cranial nerves, gait, or pupil response can be a pivotal breach of duty.
Common Misdiagnosis Patterns
Dr. Lebow reviews cases where stroke and SAH are mistaken for:
"Migraine"
Diagnosing a first-time migraine in a patient with no history, without ruling out secondary causes
"Sinusitis"
Attributing headache to sinus pressure without fever or purulent discharge
"Cervical Strain"
Dismissing neck pain (a sign of meningeal irritation) as muscle tension
Success Story: The Defendable "Miss"
Dr. Lebow has specific experience with complex hemorrhage cases. In one notable matter, he reviewed a case involving a missed subarachnoid hemorrhage that initially appeared "undefendable."
The Outcome
By carefully analyzing the medical record and the patient's specific presentation at the time of the visit, Dr. Lebow's analysis helped the defense settle the case for a small amount rather than facing a massive court judgment.
The Lesson
Not every missed diagnosis is negligence. If the patient lacked the hallmark signs at the time of the urgent care visit, Dr. Lebow can help explain why the provider's decision was reasonable.
The Urgent Care Standard vs. The ER
Plaintiff experts often argue that the patient "should have had a CT scan." Dr. Lebow counters this by clarifying the Urgent Care reality:
No CT Available
The provider cannot simply "order a scan." They must decide if the patient requires transfer to an ER.
Triage Protocol
The standard is not to diagnose the bleed, but to recognize the need for higher-level care. If the vitals were stable and the neuro exam was normal, a discharge may be defensible.
Did the Provider Miss the Signs?
Headache cases often turn on the quality of the documentation. Dr. Lebow reviews the chart to see if a neurologic exam was actually performed or if it was omitted entirely.
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