What the Health?! Woman's stroke misdiagnosed as tonsillitis

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A woman’s stroke misdiagnosis in England serves as a cautionary tale for people everywhere: never ignore what feels like the worst headache in the world.

Christine Morgan was working as a hairdresser in Kent in 2016, when she experienced a “whooshing sensation” as well as immediate, intense pain in her neck and head, according to the Daily Mail.

Her husband later called a doctor who made house calls that checked her temperature and glands.

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The physician noticed a small white lump at the back of her throat. Suspecting tonsillitis, he prescribed penicillin, even though the woman indicated that she didn’t have a sore throat or cough.

Less than a week later, Morgan was undergoing emergency open-skull surgery to treat a brain bleed.

It turns out she was experiencing subarachnoid hemorrhage, a type of life-threatening stroke often caused by a leaking or ruptured aneurysm.

The condition occurs when bleeding from a damaged blood vessel causes blood to accumulate at the surface of the brain and fill a portion of the space between the brain and the skull, according to Harvard University.

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The blood mixes with cerebrospinal fluid, which cushions the brain and spinal cord, putting increased pressure on the brain. The intense pressure causes extreme headache, which some people describe as a “thunderclap”.

In the days after the bleeding, chemical irritation from clotted blood around the brain can cause brain arteries to go into spasm, which can damage brain tissue.

“The majority of patients present with a sudden, severe, worst headache of their life,” says Dr. Michael Kelly, professor and head of neurosurgery at the Royal University Hospital of the University of Saskatchewan in Saskatoon. “People can be quite awake but with severe headache or comatose. It’s like a spectrum, but usually it’s a very bad headache in a split second. It comes on with no real warning beforehand and happens in an instant.”

“There’s an ominous sort of feeling that comes over them,” adds Kelly, Saskatchewan Clinical Stroke Research Chair. “Family members or people with them recognize there’s something quite wrong.”

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The most important factor when it comes to treatment and recovery is that quick recognition: time is of the essence.

In Morgan’s case, six days passed between her tonsillitis diagnosis and her surgery, costing her “crucial time”. She was in hospital for eight weeks and left paralyzed on the left side of her body.

In addition to terrible, sudden headache, other symptoms of subarachnoid hemorrhage include nausea and vomiting, stiff neck, dizziness, confusion, seizure, inability to look at bright light, and loss of consciousness.

Kelly urges people experiencing or witnessing such signs to call 911 immediately.

Emergency medical services will ensure that the person having the health crisis will get taken to the right hospital, one with CT scanning capability for diagnosis and advanced care for treatment, he explains.

“People with sudden, severe, worst headache of their lives should call 911 right away,” Kelly says.

According to Harvard University, many people with ruptured aneurysms or subarachnoid hemorrhages do not survive long enough to reach a hospital. Of those who do, about 50 percent die within the first month of treatment.

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Among those who survive, about half suffer long-term neurological problems. Without treatment, people are at risk of having bleeding in the brain again.

Treatment may involve surgery to repair an aneurysm with a clip to stop blood flow to it. Another therapeutic approach is endovascular embolization, in which a surgeon inserts a catheter into an artery in the groin and threads it to the brain. Detachable platinum coils are placed in the aneurysm to reduce blood flow to it.

A significant risk factor for stroke is smoking.

“One of biggest predictors for of aneurysm formation, growth, and rupture is smoking,” Kelly says. “Smoking is a big modifiable risk factor for stroke, both hemorrhagic and ischemic.”

June is Stroke Awareness Month in Canada. Stroke can happen at any age.

The easiest way to remember the signs of stroke is the FAST acronym:

F—Face: Is it drooping?

A—Arms: Can you raise both?

S—Speech: Is it slurred or jumbled?

T—Time: It’s time to call 911 right away.

If you have a sudden, severe headache that goes away, it’s still important to see a doctor. Sometimes blood leaks briefly from a vessel one or more times before a subarachnoid hemorrhage occurs, a condition called sentinel headache.

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