Neurology AdvisorMalpractice Risks in Neurology: Lessons From a $4.5 Million Stroke Verdict

⚖️ Legal / Ethical Complexity

A $4.5 million jury verdict landed on a neurologist who marked stroke imaging ‘routine’ instead of ‘stat’ and never followed up. The unfilled MRI/MRA missed a basilar artery thrombus; the patient developed locked-in syndrome and died 5 days later.

Professional Impact

• Routine-priority MRI orders for suspected stroke now carry direct liability when the order isn’t filled and the ordering neurologist doesn’t follow up.
• Plaintiff’s expert testimony framing locked-in syndrome as “a fate worse than death” anchored the jury’s sympathy and drove the high-dollar verdict.
• Awareness of hospital equipment status, including imaging downtime, now sits inside the neurologist’s documented duty of care during acute stroke workups.
• Communication breakdowns between the ordering neurologist and radiology shift liability squarely onto the neurologist who placed the original order.

Action Items

• Order every suspected stroke MRI/MRA stat regardless of NIH Stroke Scale score or initial CT findings.
• Verify completion of every time-sensitive imaging order within the expected window before leaving the patient’s chart.
• Confirm equipment availability before ordering; arrange transfer to another facility if onsite imaging is unavailable.
• Document every follow-up call, escalation, and clinical reasoning behind imaging urgency designations in the patient’s record.

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