Stroke litigation is governed by some of the most time-dependent standards in medicine. Thrombolytic windows, thrombectomy eligibility, door-to-needle and door-to-puncture benchmarks, and stroke-system transfer protocols are all defined in minutes and hours rather than in days — and most litigated stroke cases turn on what happened, and did not happen, within those windows. The medicine itself is well-characterized; what is contested is usually the sequence of decisions, the timeliness of imaging and treatment, the interpretation of findings, and the relationship between delay and outcome. My review is grounded in active stroke neurology practice at a comprehensive stroke center, in the AHA/ASA and related guideline literature, and in multicenter trial experience across this domain.
Scope
Stroke and vascular neurology covers the full range of cerebrovascular disease, acute and subacute, ischemic and hemorrhagic, with particular focus on the decision-making structures that shape outcomes.
- Acute ischemic stroke — IV thrombolysis eligibility and timing (including alteplase and tenecteplase), large-vessel occlusion recognition, mechanical thrombectomy selection and workflow, and the extended-window imaging-selection framework.
- Intracerebral hemorrhage — recognition, management of hypertension and coagulopathy, intracranial pressure management, hematoma expansion, and the analytically central question of whether earlier intervention would have altered the trajectory.
- Subarachnoid hemorrhage — aneurysmal SAH recognition (including sentinel headache and atypical presentations), diagnostic workup (CT timing, lumbar puncture, CT angiography), aneurysm securing, and the downstream complications (vasospasm, delayed cerebral ischemia) that make SAH an ongoing rather than single-event case. SAH cases often straddle stroke and neurocritical care; the analytical lens depends on where the dispute lies. See Neurocritical Care.
- Stroke systems of care — stroke-certified hospital obligations, triage and transfer protocols, drip-and-ship decisions, and the operational failures that often underlie delayed-treatment cases.
- Post-stroke complications — early and late, including hemorrhagic transformation, cerebral edema, seizures, and rehabilitation-phase medical issues when they become the basis of secondary claims.
I am an ABIME-certified Independent Medical Examiner and have served as a principal or co-principal investigator on multicenter stroke trials (MOST, CHARM, SATURN, Sleep SMART). The trial experience informs how I approach stroke cases.
Engagement
Stroke engagements are often time-sensitive — on the legal side as well as the medical side.
- Pre-retention case consultation — a structured early conversation before formal engagement.
- Records review with written analysis — structured review and written analytical summary.
- Independent medical examination (IME) — in-person or video examination, conducted under ABIME standards, with a structured written report.
- Expert report — formal written expert report suitable for disclosure.
- Deposition and trial testimony — testimony consistent with the written record.
I review for plaintiff and defense counsel on an independent basis. I decline cases outside my clinical domain, cases where the record will not support the opinion sought, and cases where my schedule will not permit the attention the work requires.
Related Writings
Writings on stroke and vascular neurology, for counsel wanting to see how I reason about these cases before engaging.
- Delayed Stroke Diagnosis: Breach, Causation, and the Treatment Window — Commentary on the analytical spine of most delayed-diagnosis stroke cases.
- Missed Subarachnoid Hemorrhage: The Case That Turns on the History — Commentary on why most missed SAH is lost in the history rather than the imaging.
- Neuroimaging in Litigation: What It Shows, What It Does Not Prove — Primer on what CT, MRI, and advanced imaging can and cannot support in stroke cases.