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The Expert: Dr. Michael Gold, a neurologist based in Santa Monica, California, testifies for the plaintiff concerning the stroke she suffered.
Santa Monica-based neurologist, Dr. Michael Gold, testifies for the plaintiff in a 2015 Florida medical malpractice trial. In this trial, the plaintiff claimed that she suffered an air embolism, which led to partial blindness during her hysterectomy.
The neurologist states plainly from the beginning that the plaintiff suffered a stroke during her hysterectomy and that this was due to an air bubble entering a pelvic vein and traveling to her brain, preventing the adequate delivery of oxygenated blood to that portion of the brain that interprets visual input. He believes that this likely occurred when there was a sudden change in the patient’s pulse and blood pressure as recorded in the anesthesia record. The expert opines that if timely intervention had occurred at that point, the damages that subsequently became permanent might have been “dramatically lessened” or eliminated.
Explaining the anatomy of the body’s circulation, Gold describes the venous system as the “blue blood” system that transports the blood after it has had the oxygen removed from it for the body’s needs. Once used like this, the blood needs to be transported back to the right side of the heart where it is pumped into the lungs to resupply the unoxygenated blood with oxygen. After reoxygenation, the blood returns to the left side of the heart and from there is taken to the rest of the body by the arterial system.
In gynecologic surgeries, large pelvic veins are frequently opened as part of the operation, and this can be a point of entry for air to get into the bloodstream. Once entering, the air travels through the veins to the right side of the heart. In a person with normal anatomy, the air would then be forced into the lung vasculature. If a large enough volume of air is involved, this would result in a symptomatic pulmonary embolism. If a small amount of air is embolized into the lungs, it may remain asymptomatic and eventually be absorbed there.
In a patient that has a heart defect called a Patent Foramen Ovale, an abnormally persistent hole in the septum between the right and left sides of the heart that has been present since birth, the air traveling within the veins can be force from the right to the left side through that hole without first going to the lungs. Once within the left side of the heart, the air bubble can be transported to the brain. It can end up in any part of the brain, and the subsequent symptomatology is dependent upon the area of the brain’s circulation that is blocked by the air bubble.
A stroke like this shows up on CT scan images as well as MRI images, and its timing can be approximated with serial imaging. The expert says that using these images, as well as the anesthesia record of sudden vital sign changes, he feels confident that the damage occurred during the operative procedure around 12:30 PM.
Using props, he shows the jury that the occipital lobe of the brain was damaged. This is the area of the brain where vision is interpreted within its cortex or outer layers, and the resulting visual deficits are therefore referred to as cortical blindness. The brain cannot interpret the information that the eye is accurately presenting to it. The resulting functional deficit is cortical blindness as opposed to eye blindness. The plaintiff in this case suffered a stroke that caused her to have cortical blindness. As the jury deliberated, a settlement was agreed to.
Gary Gansar, MD, is residency-trained in general surgery. He served as Chief of Surgery and Staff at Elmwood Medical Center and on the Medical Executive Committee at Touro Infirmary and Mercy Hospital in New Orleans, LA. Dr. Gansar was Board Certified in general surgery while in active practice. He joined AMFS in 2015 as a Physician Medical Director.
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