Page Section: Centre Content Column
Rare neurosurgical emergency misdiagnosed as migraine (08HDC00248)
Download Rare neurosurgical emergency misdiagnosed as migraine (08HDC00248) (PDF 139Kb)
(08HDC00248, 26 September
Physician ~ Public hospital ~ District health board ~
Emergency department ~ Clinical records ~ Migraine ~ Raised
intracranial pressure ~ Right 4(1)
A woman in her forties had a long history of migraine headaches.
She underwent successful neurosurgery, which alleviated her
The following year, she fell at home and her headaches returned.
Although she was referred for a CT scan, it was not performed, as
emergency department staff considered that her symptoms were
related to her migraine. Notwithstanding this, staff noted the need
to adopt a low threshold for a CT head scan if her headache
The woman presented at the hospital with a debilitating headache
in the early hours of the morning. Her admitting consultant
physician considered her symptoms migrainous in nature and
prescribed her with medication for treating migraines. The
consultant did not have access to the emergency department notes
from an admission two months earlier, and was unaware of the need
to adopt a low threshold for ordering a CT scan. Initially, the
woman responded well to the medication. However, her level of
consciousness deteriorated over the course of the day, which was
attributed to the medication she had received. The following day,
her condition deteriorated further, and she required resuscitation.
Despite transfer to the intensive care unit, her condition
continued to worsen, and she was pronounced brain dead.
A post-mortem examination found that the woman had suffered a
very rare complication following the neurosurgery a year
It was held that the consultant breached Right 4(1) for omitting
to review the woman on her second night in hospital, and for not
requesting a CT scan at that point. He also breached Right 4(1) for
failing to respond appropriately when she deteriorated further the
Various systems issues at the public hospital contributed to the
tragic outcome, and the DHB was held to have breached Right 4(1).
These included the absence of the woman's previous emergency
department notes when she re-presented at the emergency department
two months later, the length of time she spent at the emergency
department before being transferred to the medical ward, and the
reduced radiology services after hours.