In this medical malpractice action, plaintiffs alleged that defendant Dr. Robert S. April was negligent in, among other things, failing to order diagnostic testing that could have revealed the presence of a micro-arteriovenous malformation (AVM), a congenital condition in the injured plaintiff's brain. According to plaintiffs, had Dr. April ordered the proper tests, the injured plaintiff might not have suffered neurological damage, which, she alleges, has led to seizures, headaches, difficulty with her sense of balance, and impaired spatial vision.

Defendants failed to establish their entitlement to judgment as a matter of law. On their motion, defendants submitted, among other things, the injured plaintiff's medical records and an affirmation of a neurologist, both of which purported to demonstrate that the alleged deviations from the accepted standard of medical care did not proximately cause plaintiff's damages. Those documents showed that plaintiff's AVM was not visible on noninvasive diagnostic testing, but would have been visible only by invasive cerebral angiography. Defendants noted that the latter test, however, would have been inconsistent with the standard of care, as it carried significant risks inappropriate for that stage of treatment. Further, defendants *570 argued, the assertion that they should have performed a cerebral angiography before plaintiff's hemorrhage did not support the medical malpractice claim, because the bleed had already occurred and any subsequent testing would not have changed the course of plaintiff's health (see Foster-Sturrup v Long, 95 AD3d 726, 727-728 [1st Dept 2012]). This showing was sufficient for defendants to make out a prima facie case of their entitlement to summary judgment. The burden therefore shifted to plaintiffs to present evidence in admissible form demonstrating the existence of triable issues of fact (see Zuckerman v City of New York, 49 NY2d 557, 562 [1980]).

Here, plaintiffs did sufficiently make that showing in their opposition, presenting evidence that raised triable issues of fact by way of their neurological expert's opinion. The neurological expert examined plaintiff's chart, particularly her various complaints over time of recurrent falls, vision failure, and headaches. After that review, the neurologist opined that Dr. April deviated from the standard of care by failing to engage in a differential diagnosis, failing to order a cerebral angiography and other tests such as MRIs and MRAs, engaging in “head shaking” or “head impact testing,” prescribing contraindicated medications, and failing to obtain *5 a neurological consultation. According to plaintiffs' expert, with a reasonable degree of medical certainty, these departures, particularly the failure to order and have performed the indicated tests between November 2, and November 30, 2010, prevented early detection and removal of the AVM before its rupture, causing plaintiff's injuries. This conclusion was sufficiently particularized to raise triable issues of fact, thus defeating defendants' motion for summary judgment (see Polanco v Reed, 105 AD3d 438, 440-441 [1st Dept 2013]).

As defendants concede on appeal, no party disputes that an angiogram would have revealed the congenital malformation in plaintiff's brain. But the question is whether the angiogram was actually indicated. Plaintiffs' expert directly addresses this question in the expert affirmation, stating that given plaintiff's history and the clinical course of her neurological deterioration, defendants should have performed a differential diagnosis of her symptoms to rule out various possible conditions, including seizure disorder or intracranial infection. There is nothing conclusory about this opinion; it simply creates a question of fact as to whether defendants should have performed a differential diagnosis before the AVM advanced to the point where it caused permanent neurological damage (see Adams v Pilarte, 152 AD3d 97 [1st Dept 2017]). *571

That plaintiffs' expert offers an opinion in the disjunctive, as the majority notes, does not change the result (“Dr. April deviated from the accepted standard of medical care in not ordering indicated tests . . . including cerebral MRI [magnetic resonance imaging test] and MRA [magnetic resonance angiogram] or . . . conventional cerebral angiography”). On the contrary, the very point of plaintiffs' expert's opinion is that the failure to order any sort of test other than an EEG was part of defendants' failure to perform a differential diagnosis.

The cases that the majority cites do not compel any result to the contrary. In David v Hutchinson (114 AD3d 412, 412 [1st Dept 2014]), the decedent complained of abdominal pain during an emergency room visit following gallbladder removal surgery 11 days earlier. The defendants diagnosed an infection and treated the decedent for that condition, after which her complaints resolved and she was discharged after being “stable and comfortable” for several hours (id. at 412, 413). The decedent was later found to have liver abscesses and pleural effusion, and died from infections related to her repeated stays in hospitals and nursing homes (id. at 412). Under those circumstances, we found, among other things, that the failure to investigate a condition that would have led to an incidental discovery of an unindicated condition does not constitute malpractice (id. at 413).

But the question here is not one of incidental discovery of an unindicated condition. In David, none of the decedent's symptoms pointed to a liver abscess or pleural effusion; thus, we found in that case that the failure to test for those conditions did not constitute a deviation from the standard of care (114 AD3d at 413). Here, by contrast, as plaintiffs' expert notes in the expert affirmation, plaintiff's symptoms might well have pointed to an AVM—a condition that defendants would have discovered had they undertaken the correct diagnostic procedures.

What is more, the defense experts in David stated, without contradiction, that the decedent's liver abscesses had long since resolved by the time of her death, and the plaintiff's expert was unable to causally relate the liver abscesses to the decedent's death (114 AD3d at 413). Thus, in David, the decedent's death was not even legally connected to the condition that the defendants allegedly failed to diagnose. Here, in contrast to David, no expert states that plaintiff's “blinding” headaches, visual disturbances, and difficulty walking proved unrelated to her condition. Quite to the contrary, plaintiffs' expert opines that plaintiff's symptoms were consistent with an AVM, among other things. *572

In Montilla v St. Luke's-Roosevelt Hosp. (147 AD3d 404, 407 [1st Dept 2017]), the plaintiff's expert never addressed the assertion of the defendant's expert that there was no radiological evidence of trauma in the decedent's brain, and omitted facts regarding the rise in the decedent's blood pressure, thus ignoring relevant record evidence about what had caused the decedent's injury. As noted above, plaintiffs' expert directly addresses the issues raised by *6 defendants' expert. Nor does the majority point to any relevant record evidence that plaintiffs' expert ignored in reaching his or her conclusion. [Prior Case History: 2016 NY Slip Op 31303(U).]