3 y/o atlanto-occipital dislocation (Case #403)

• Medical Probability: 6 / 10
• Medical Error Summary: Difficult to determine the ideology of the injury without reviewing the initial images. Concerning that the patient had increasing pain
• Causation Probability: 6 / 10
• Causation Summary: Motor vehicle crashes typically have high impact and at this age group no more likely location of injury is in the upper cervical spine.
• Expert Summary: Area of expertise includes cervical spine pathology.
• Similar Summary: at least once a month. encounter cases similar to this one.

Looking for a pediatric neurosurgeon (Case #517)

• Medical Probability: 8 / 10
• Medical Error Summary: Irritability, vomiting and bradycardia lead to a CT scan on 8/15/2019. Given the clinical concern and imaging finding with the location of the new L catheter that was coiled it would have warranted fu...
• Causation Probability: 8 / 10
• Causation Summary: Spinal cord signal abnormality (possible brainstem compression) and seizures raises concern of a neurologic insult
• Expert Summary: I am expert in pediatric neurosurgery and Department Head of Neurosciences with extensive experience managing hydrocephalus, VP shunt placement and revision, shunt infections, and emergencies involvin...
• Similar Summary: Several in a year with this presentation

19yo male VP Shunt Failure Resulting in Death (Case #525)

• Medical Probability: 6 / 10
• Medical Error Summary: Workrkup was adequate per basic standards but potentially insufficient pending more information regarding shunt tap, imaging and symptoms.
• Causation Probability: 7 / 10
• Causation Summary: Likely contributory, possibly substantial, but causation is probabilistic rather than certain without full record review
• Expert Summary: Chief of pediatric neurosurgery with more than a decade experience in the treatment and management of hydrocephalus
• Similar Summary: on a daily basis I encounter cases similar to this patient

Surgeon performed a C7-T1 fusion that was not consented to by the patient. (Case #550)

• Medical Probability: 7 / 10
• Medical Error Summary: This case would likely be viewed as below standard of care most likely especially with documented "mistake" admission by the physician. It would benefit from a full pre-op imaging review and all int...
• Causation Probability: 7 / 10
• Causation Summary: Could be localization error and incorrect fusion level but would benefit from a more detailed review
• Expert Summary: I am an academic neurosurgeon with experience in adult and pediatric neurosurgery and spine deformity
• Similar Summary: very rarely do i see similar cases like this

27-year-old female w/ pseudotumor cerebri - Shunt failure. (Case #551)

• Medical Probability: 7 / 10
• Medical Error Summary: Elevated ICP can exist without papilledema. Also there is no clear time frame of developping papilledema. Absence of this finding does not rule it out. Optic nerve fenestration can prevent or signif...
• Causation Probability: 7 / 10
• Causation Summary: Shunt revision promptly improved imaging and decreased posterior globe flattening and stabilized the patient.
• Expert Summary: In my practice as an adult and pediatric neurosurgeon I lead a dedicated multidisciplinary clinic for idiopathic intracranial hypertension (IIH). In this clinic we manage hundreds of complex IIH
• Similar Summary: Once or twice a year we see a complicated case that is a miss or near miss

Spinal cord compression and irreversible nerve damage from cauda equina syndrome. (Case #552)

• Medical Probability: 4 / 10
• Medical Error Summary: Holding apixaban for ~2–3 days before this surgery is reasonable and also dependent on risk factors from the heart standpoint. Epidural hematomas can also occur even without anticoagulation.
• Causation Probability: 4 / 10
• Causation Summary: Not every hematoma on anticoagulation equals malpractice-level causation, as these events can occur despite proper management
• Expert Summary: I operate on complex heart patients on anticoagulation and have written on this specific topic several times
• Similar Summary: once or twice a year we encounter a similar case

LLE weakness and left foot drop after spinal cord stimulator replacement with thoracic cord/dural injury. (Case #570)

• Medical Probability: 6 / 10
• Medical Error Summary: The amount of force necessary to push this device into the dura and spinal cord and the severity and persistence of the patient’s deficits, combined with postoperative imaging suggesting spinal cord...
• Causation Probability: 9 / 10
• Causation Summary: There is a strong temporal and clinical relationship between the surgery and the patient’s injuries. Before surgery, the patient had chronic pain but was ambulatory and functioning independently. Im...
• Expert Summary: I am familiar with postoperative neurologic complications following spine surgery. I am experienced in reviewing causation, standard-of-care issues, operative documentation, and postoperative rehabili...
• Similar Summary: I encounter postoperative spine surgery complications and chronic pain/spinal cord stimulator cases on a regular basis.