A stroke misdiagnosis claim arises when a patient having a stroke, or a transient ischemic attack (TIA) warning of one, is diagnosed with something else, and the delay costs them treatment that could have limited brain damage. In Virginia, these cases are medical malpractice claims, and they depend on precise timing: when symptoms started, when the patient was seen, and when treatment was still possible.
Blank Kim Injury Law represents stroke survivors and their families across Northern Virginia from our Fairfax office. Many stroke survivors cannot fully speak for themselves, so we work closely with spouses and adult children to reconstruct what happened. Robert Kim speaks Korean, and our paralegals speak Spanish.
Stroke symptoms a provider should recognize
Public health campaigns teach BE FAST, and emergency staff are trained on the same signs:
- Balance: sudden loss of balance, dizziness or trouble walking
- Eyes: sudden vision loss or double vision
- Face: drooping on one side
- Arm: weakness or numbness on one side
- Speech: slurred speech, or trouble finding or understanding words
- Time: note when symptoms started and call 911
Other presentations are easier to miss. A sudden, severe “worst headache of my life” can signal bleeding in the brain. Strokes in the back of the brain, the posterior circulation, can cause vertigo, vomiting, clumsiness and unsteady walking with little or no arm or face weakness. These are the strokes most often sent home.
What strokes are mistaken for
Some conditions truly imitate a stroke, and a careful workup tells them apart. The problem arises when the easier diagnosis is chosen without that workup:
- Inner ear vertigo. The most common trap. Bedside tests such as the HINTS exam, which checks eye movements, can help distinguish a peripheral cause from a stroke when performed and interpreted correctly.
- Migraine. Especially in younger patients, and particularly when this headache is different from past ones.
- Intoxication. Slurred speech and an unsteady walk are blamed on alcohol, without a blood alcohol level or a neurologic exam.
- Low blood sugar. It causes stroke-like symptoms and takes a finger stick to check, but checking it is where the workup starts, not where it ends.
- Seizure, Bell’s palsy or anxiety. Each is real, and each is a diagnosis to reach only after stroke is excluded.
Patients under 50, women and patients whose main complaint is dizziness are at particular risk of a missed stroke. Standard stroke severity scales can also understate strokes in the back of the brain, so a low score does not end the inquiry.
Why minutes matter: stroke treatment windows
Most strokes are ischemic, caused by a clot blocking blood flow. Every minute of blocked flow kills brain cells, and the treatments that restore flow only work within limited windows measured from the time the patient was last known to be well:
| Treatment | General time frame | What it requires |
|---|---|---|
| Clot-dissolving medication (alteplase or tenecteplase) | Generally within 4.5 hours of last known well | Brain imaging first, to rule out bleeding |
| Mechanical thrombectomy (clot removal) | Up to 24 hours in selected patients | Imaging of the blood vessels to find a large blocked artery, and access to a center that performs the procedure |
| Treatment for a bleeding stroke | Immediately | Blood pressure control, reversal of blood thinners and neurosurgical evaluation |
| TIA workup and prevention | Promptly, ideally before discharge | Vessel imaging, heart rhythm monitoring and starting preventive medication |
Hospitals track door-to-needle time, and national quality programs set targets for giving clot-dissolving medication within about an hour of arrival. A patient who arrives in time and leaves with a vertigo prescription has lost options that do not come back.
Imaging mistakes in stroke cases
A normal CT scan of the head does not rule out a stroke. Non-contrast CT is excellent at showing bleeding, but in the first hours of an ischemic stroke it is often normal. MRI with diffusion-weighted imaging is far more sensitive, and CT angiography shows whether a large artery is blocked.
Common imaging errors include treating a normal CT as the end of the workup, failing to image the blood vessels in a patient who might need clot removal, and missing a small bleed that signals a leaking aneurysm. When a radiologist’s reading is at issue, our page on radiology errors explains how those claims are reviewed.
Transient ischemic attacks: the warning that gets sent home
A TIA causes stroke symptoms that go away, often within minutes. Because the patient looks fine by the time a doctor sees them, TIAs are easy to dismiss. Yet the risk of a full stroke is highest in the days right after a TIA, and prompt evaluation and treatment reduce it.
Risk tools such as the ABCD2 score help decide how urgent the workup is. A patient discharged without vessel imaging, heart rhythm evaluation or preventive medication, who then has a disabling stroke days later, has the kind of case we review closely.
Records that show what happened
Stroke cases are built on time stamps. The records we obtain include:
- The ambulance run report, including any prehospital stroke scale and the time of the 911 call
- The “last known well” time recorded at triage, and whether it was accurate
- Whether a stroke alert was called, and when
- Glucose checks, neurologic exams and stroke severity scores
- CT and CT angiography order times, scan times and reading times
- Neurology or telestroke consultation notes and call logs
- Transfer records if the patient was moved to another hospital
A physician in emergency medicine reviews what should have happened at each step. A neurologist then explains what timely treatment would likely have achieved, which is the causation question that decides most stroke cases.
Stroke misdiagnosis claims under Virginia law
A stroke patient in Virginia is entitled to care that meets a statewide standard, under Va. Code § 8.01-581.20. Whether the patient walked into the emergency department at Inova Fairfax Medical Campus, an urgent care center in Chantilly or a hospital in Loudoun County, the question is what a reasonably prudent provider in that role would have done with the same symptoms.
- The claim must be supported by a qualified expert witness’s written opinion before suit is served, under Va. Code § 8.01-20.1.
- The general deadline is two years from the act of malpractice, under Va. Code § 8.01-243(A).
- Total damages are capped under Va. Code § 8.01-581.15.
Stroke survivors often face paralysis, speech loss and long-term care costs. Our page on brain injury claims describes how lasting brain damage is documented. When a missed stroke is fatal, the family’s options are on our malpractice wrongful death page.
