A 49-year-old registered nurse took an overdose of Percocet due to depression, which she had suffered from along with chronic back pain for over a year. She was admitted to the psychiatric ward of a major hospital. The attending psychiatrist prescribed electroconvulsive therapy (ECT) for six sessions. Immediately following the first session the patient complained of headache, as though "something hit the back of [her] head" and nausea. The psychiatrist noted the next day patient's major headache did not respond to Tylenol or Percocet. The second ECT treatment was performed that day. The patient was noted to have a left-sided headache, neck pain, jaw pain, nausea and vomiting the next day. The third ECT treatment was performed. On Day 4, after the fourth treatment, the patient's left eyelid was described as swollen and the headaches continuing. Four days later the fifth ECT was performed, after which the physician noted a new left facial weakness and left upper extremity clumsiness. A CT scan showed a 4 x 4 cm right, frontal hematoma with right to left brain shift. THE MRI/MRA showed infarcts in the left corona radiate, water-shed zone; right frontal hematoma; small, basilar tip aneurysm; and left petrous carotid dissection. A neurosurgery exam found a left ptosis and left facial palsy. A neurology consult found pupillary asymmetry, a left ptosis, left flattened nasolabial fold, left Horner's syndrome and mild right and left upper extremity weakness. The patient underwent an angiogram, at which time a right carotid dissection occurred. The occlusion resulted in a right hemisphere ischemic stroke. The patient remains totally dependent left hemiparisis and speech and memory deficits. A medQuest psychiatrist and neuropsychiatrist independently found negligent management of the ECT treatments, which should have been stopped. The patient's complaints of severe pain were ignored. A medQuest neurosurgeon reported the left carotid dissection likely occurred after the initial ECT treatment. At the end of the ECT course the patient developed the hematoma, resulting in left facial and arm weakness and possibly caused by elevated blood pressure from the ECT or hemorrhagic infarct from a right carotid dissection. If the initial left carotid dissection had been diagnosed in a timely fashion, the later ECT treatments and resulting complications may have been avoided.