The consequences of a delayed or missed diagnosis of a stroke
By Alison Johnson, clinical negligence partner, Penningtons Manches Cooper
Every five minutes someone suffers a stroke in the UK. It is a shocking statistic, especially when strokes can happen very quickly, without warning and can affect children as well as older people. Even when someone receives good medical care and survives a stroke brain injury, they may be left with long-term disabilities.
If there is a delay in a stroke diagnosis and delayed treatment for it, more extensive neurological damage may occur, leaving a patient paralysed or permanently disabled. Brain injuries can have severe symptoms leading to loss of certain functions including speech, mobility and personality changes.
There are three main types of strokes – ischemic, embolic and haemorrhagic – which require different treatments:
- An ischemic stroke occurs when blood flow to part of the brain is cut off, due to a blocked or clogged blood vessel.
- An embolic stroke occurs when a blood clot breaks free and blocks circulation to the brain, again depriving it of blood and oxygen.
- A haemorrhagic stroke occurs when blood vessels in the brain leak or rupture, causing blood to build up and put pressure on surrounding areas, resulting in the death of brain tissue.
Regardless of the type of stroke, rapid diagnosis and treatment are key to reducing long-term disability.
Treatment options
Given the severity of the symptoms a stroke can cause, it is essential that good medical care is given as a matter of urgency, even if it is deemed survivable.
When an ischemic or embolic stroke has occurred and medical treatment is commenced within a six-hour window, medication called TPA can be given to reverse the effect of a stroke and to break up blood clots.
The sooner the TPA is administered, the better the outcome.
Alison Johnson
Other more advanced treatment options may be available including CT-guided catheter delivery of clot-busting medication (direct to the location of the clot) and mechanical thrombectomy (where the clot is broken down by tiny surgical tools and removed through a blood vessel) to try to dissolve or remove the clot as quickly and efficiently as possible after the onset of symptoms.
The patient may then take aspirin and anticoagulants to reduce the chances of future blood clots. Where a haemorrhagic stroke has occurred, thrombolysis medication is not given as it would make the bleed worse and the brain injury more severe. Instead, a surgery called a craniotomy can be performed to reduce pressure on the brain. Again, time is of the essence as the longer the bleed has continued, the greater the brain damage it will have caused.
The following four actions are essential to save the life of a stroke patient and to preserve as much brain function as possible:
- Taking a history of the onset of the symptoms
- Undertaking the correct investigations (probably a brain CT scan initially)
- A prompt diagnosis of stroke and the nature of the stroke (differentiating between the three types)
- Good decision-making and skilled treatment.
Tragically, about one in 10 cases of strokes are regularly misdiagnosed or diagnosed late. This is probably due to symptoms such as headache, vertigo, confused or slurred speech mimicking other conditions. However, failure to determine the specific type of stroke (ischaemic, embolic or haemorrhagic) or misdiagnosing a stroke as another illness or condition can drastically affect a patient’s chance of recovery.
A clinical negligence investigation can look into an incidence of suspected misdiagnosis or delayed diagnosis of stroke if it is believed that earlier treatment would have made a difference and given the stroke patient a better outcome.
If a claim is proven, the level of compensation that may be due will depend upon the severity of a client’s injuries and the change in lifestyle they have suffered as a result. Stroke misdiagnosis claims do, however, like other severe brain injury damages claims, attract significant compensation.
Approximately a quarter of strokes happen to a younger person or a child. Doctors will often refer to brain bleeds, rather than strokes, given the misconception that strokes only happen to older people.
About the Author
Alison Johnson is a leading clinical negligence solicitor based in the southeast of England but representing clients nationwide. She has worked with individuals and families impacted by medical negligence for over 20 years.
She is a member of Action against Medical Accidents’ (AvMA) Clinical Negligence Panel and listed as a next generation partner in Chambers UK and Legal 500, gaining acknowledgement of her hugely effective combination of intelligence, empathy and sound judgement, ability to put clients at ease and for being a very good and effective litigator.
Alison is available for an initial chat about a new or existing clinical negligence claim and can be reached at: alison.johnson@penningtonslaw.com
