Opinion ID: 2820422
Heading Depth: 3
Heading Rank: 1

Heading: Brain and Neurological Issues

Text: On May 8, 2010, Hubbard went to the Medical Center of Central Georgia (“MCCG”) Emergency Center complaining of slurred speech, right-arm pain and weakness, headache, and blurred vision. The doctor conducted a stroke evaluation 4 Case: 14-14908 Date Filed: 07/27/2015 Page: 5 of 18 and determined that Hubbard had suffered a transient ischemic attack. 1 The doctor suspected polysubstance abuse as a cause. Doctors performed a computerized tomography (“CT”) scan of Hubbard’s brain, which appeared normal. Hubbard underwent magnetic resonance imaging (“MRI”) of her brain at a follow-up visit on August 24, 2010. The MRI revealed some abnormalities in Hubbard’s white matter, as well as a small lesion on her pituitary gland. On September 7, 2010, Hubbard presented at the MCCG complaining of a chronic headache, and she was referred to a neurologist based on her previous MRI results. On September 15, Hubbard had a CT scan of her pituitary area. Based on the CT scan, the neurologist noted pituitary abnormalities that could be consistent with such a lesion, but could not confirm its presence. Another CT scan on October 4, 2010, was normal. An MRI the same day revealed some abnormalities in Hubbard’s white matter, which were “common and nonspecific,” as well as “shortening along the posterior pituitary,” which was “of doubtful clinical significance.” In October 2010 Hubbard suffered an episode during which she felt very hot, passed out while walking to her car, and was unconscious for approximately ten minutes. No cause for this episode is reflected in the medical records. 1 A transient ischemic attack, or “mini-stroke,” is an acute episode of temporary neurological dysfunction that occurs when blood flow to a part of the brain stops for a brief time. 5 Case: 14-14908 Date Filed: 07/27/2015 Page: 6 of 18 In February 2011, another CT scan of Hubbard’s brain was taken after she developed a severe headache following a spinal tap. There were no changes from the CT scan in May 2010. Additional MRI brain scans in March 2011 showed a moderate degree of white-matter disease, which was unusual for a person of Hubbard’s age. Compared to her August 2010 MRI, the white-matter lesions had increased only minimally, and her pituitary lesion had not changed significantly. On March 23, 2011, Hubbard underwent CT angiography (“CTA”) of her head and neck, which revealed no evidence of an acute intracranial process. On July 29, 2011, Hubbard went to the Emergency Center after suffering a syncopal (fainting) episode in a restaurant. In treatment notes, the treating physician included polysubstance usage (marijuana and cocaine) among the possible causes. A CT scan was also performed on that date, and it revealed no change from Hubbard’s February 2011 CT scan. On October 8, 2012, Hubbard went to the Emergency Center complaining of a worsening headache, which she attributed to a pituitary tumor. Hubbard was given pain medication, which relieved her headache, and she was released.