A VERDICT of misadventure was returned at an inquest yesterday on a 40-year-old doctor and mother of three who died after she was misdiagnosed as having a migraine rather than a brain haemorrhage.
She was sent home from hospital only to be readmitted a day later to undergo emergency surgery which ultimately proved unsuccessful.
Dr Niamh Long died from brain swelling due to extensive cerebral infarction or disease due to the clipping of the left internal carotid artery during emergency treatment for a sub-arachnoid haemorrhage at Cork University Hospital on January 11th, 2011.
A jury of three men and three women yesterday returned a verdict of medical misadventure in the case of Dr Long from Endsleigh, Douglas Road, Cork, after hearing almost four hours of evidence at Cork City Coroner's Court yesterday.
The inquest heard how Dr Long had been admitted by ambulance to the Cork hospital in January complaining of severe headaches where she was seen by registrar in emergency medicine Dr Gergely Halasz who diagnosed her as suffering from migraine or cluster headaches.
Dr Halasz told the inquest that Dr Long was alert, oriented and had good cognitive function and she did not display what he classified as "red flag symptoms" and was improving when she was discharged that evening after he diagnosed her as suffering from a migraine.
Dr Halasz said he did not recommend a CT scan as he did not believe it was necessary but did give Dr Long a prescription for medication when she was being discharged that evening. He accepted he had misdiagnosed her "My diagnosis was incorrect - that's true," he said.
Dr Long's GP, Dr Kieran O'Keeffe, said he was concerned she had had "a cerebral event" when he saw her the next day as she reported having lost consciousness, experienced an episode of urinary incontinence and suffered from confusion so he contacted the hospital.
Dr Long was admitted to the hospital where she was seen by Prof Stephen Cusack, a consultant in emergency medicine, who ordered a CT scan which showed she had suffered a subarachnoid haemorrhage in the left carotid artery.
Consultant radiologist Dr Noel Fanning said such haemorrhages or brain aneurysms can be treated by either endavascular coiling where a piece of plastic tubing is inserted in the femoral artery and navigated to the site of the aneurysm or by surgery. But he believed Dr Long's aneurysm could not be treated by coiling due to both its type and location, being a blister bleed aneurysm on a segment of dysplastic or diseased artery so he contacted neurosurgeon Charles Marks who operated on her on January 8th.
Mr Marks, for whom Dr Long had once worked as an intern, said it was a particularly difficult procedure to perform and it was the first time he had come across such a blood blister aneurysm and when he tried to clip it, he cut across, causing a hole which began to bleed.
He spent 90 minutes trying to put various clips on the aneurysm but each time they slipped off when blood started pulsing through the artery and he was forced to clip the entire carotid artery. "In hindsight my decision to clip [ the aneurysm] was probably wrong," he said.
"This was one of the most desperate things I have done in a long career in surgery - I don't panic but I was close to panic as I get," said Mr Marks, adding "he was very sorry to everybody" for the decision he had made.
Dr Long died three days later and yesterday, Dr Long's husband, Eoin Clifford, described her as "a wonderful wife and mother and her passing has left an incalculable void in the lives of those closest to her particularly for me and our three girls".
Deputy Cork city coroner, Phillip Comyn extended his sympathies to Dr Long's family and noted that their decision to donate her organs had helped a number of people including a liver transplant patient and a kidney transplant patient.