Missed Strokes in the ER: Why Time Lost Means Brain Lost

By Hendrickson Law | Missouri Medical Malpractice Attorneys

When someone shows up at an emergency room with stroke symptoms, every minute matters. Brain cells die with each passing moment. A fast, accurate diagnosis can mean the difference between a full recovery and a lifetime of disability — or death.

Yet too often, stroke patients are sent home misdiagnosed, or their treatment is delayed until it’s too late. These are not rare mistakes; they’re among the most common and devastating forms of emergency room malpractice we see at Hendrickson Law.


Why “Time Is Brain” Isn’t Just a Slogan

A stroke occurs when the blood supply to part of the brain is interrupted — either by a clot (ischemic stroke) or a bleed (hemorrhagic stroke). Without oxygen, brain tissue begins to die within minutes.

The American Heart Association and the American Stroke Association both stress the same rule:

Treat suspected stroke immediately — every minute of delay kills brain cells.

For an ischemic stroke, the standard treatment is a clot-busting medication called tPA (tissue plasminogen activator), but it must be given within a narrow window — typically 3 to 4.5 hours from symptom onset. Beyond that, the damage is often irreversible.


Common Emergency Room Stroke Errors

Despite clear guidelines, ER physicians and hospitals still make preventable mistakes that cost patients their independence — or their lives.

1. Failure to Recognize Stroke Symptoms

ER staff sometimes attribute stroke symptoms to less serious causes like:

  • Vertigo or “inner ear issues”

  • Migraine

  • Anxiety or panic attack

  • Intoxication or drug reaction

  • Hypoglycemia (low blood sugar)

This happens especially when symptoms are subtle, come and go (as in transient ischemic attacks or TIAs), or when the patient is young or female.


2. Delay in Ordering a CT or MRI Scan

CT imaging is essential to distinguish between ischemic and hemorrhagic stroke. In many malpractice cases, the delay isn’t just minutes — it’s hours.

If the scan isn’t ordered immediately, or if there’s a backlog or miscommunication, the window for life-saving intervention closes.


3. Failure to Activate a “Stroke Alert” Protocol

Most hospitals have stroke response systems designed to fast-track patients through imaging and neurology consults. When ER staff fail to trigger these protocols, the entire chain of care slows down — and the patient pays the price.


4. Improper Discharge

We’ve handled cases where patients were sent home from the ER with clear stroke warning signs — one side weakness, slurred speech, drooping face — told to “rest” or “hydrate.”
They return hours later paralyzed or unable to speak.


Case Example

A 56-year-old man arrives at a Missouri ER complaining of dizziness, double vision, and unsteady walking. The ER doctor diagnoses “vertigo” without ordering a CT scan.
Twelve hours later, he collapses at home from a brainstem stroke.
He survives — but cannot walk or swallow independently again.

That was not an unpredictable complication.
It was a failure to recognize and act on classic stroke symptoms.


The Standard of Care for Stroke in the ER

According to national guidelines (AHA/ASA, ACEP, and Joint Commission), ER providers must:

  • Perform and document a neurological exam on any patient with sudden weakness, speech issues, vision loss, or dizziness

  • Immediately order head imaging (CT or MRI) to rule out stroke

  • Activate the hospital’s stroke protocol without delay

  • Consult a neurologist or stroke specialist promptly

  • Administer tPA or transfer the patient to a facility that can

When these steps are skipped or delayed, and the patient suffers permanent harm, it’s not “just bad luck.” It’s malpractice.


Why Strokes Get Missed

Even skilled doctors can fall prey to cognitive biases:

  • Anchoring bias: Latching onto the first diagnosis that comes to mind (“vertigo” or “anxiety”).

  • Availability bias: Assuming a rare presentation can’t be a serious problem.

  • Confirmation bias: Ignoring data that contradicts their initial impression.

ER physicians must guard against these biases. That’s why medical standards exist — to ensure personal judgment doesn’t override safety.


How Hendrickson Law Investigates Stroke Malpractice

When we review a stroke case, we look at:

  • Triage timing and documentation (Was stroke considered at all?)

  • Nursing and physician notes

  • CT/MRI timestamps and order logs

  • Hospital “stroke alert” policies

  • Audit trails showing when results were reviewed and acted on

We work with neurologists and ER experts to pinpoint where the delay occurred — and whether earlier intervention could have changed the outcome.


The Real-World Cost of a Missed Stroke

A missed or delayed stroke diagnosis can leave a person unable to walk, talk, or care for themselves. Families are left with lifelong caregiving burdens, enormous medical bills, and unanswered questions.

These aren’t “bad outcomes.” They’re avoidable tragedies.


If You Believe a Stroke Was Missed or Mishandled in the ER

Call Hendrickson Law at (314) 721-8833 or visit www.hendricksonlaw.com for a free consultation.

We represent patients and families throughout Missouri in cases involving ER negligence, delayed diagnosis, and stroke-related malpractice.

When hospitals lose time, patients lose lives. We hold them accountable.