Stroke is the most common non-traumatic cause of acquired brain injury. Catherine Bell of Brain Injury Group member firm Freeths Solicitors looks at when there might be a clinical negligence claim after someone has suffered a stroke.
What is a stroke?
A stroke occurs when the blood supply to part of the brain is blocked or cut off either by a bleed (haemorrhagic stroke) or by a blood clot (ischaemic stroke). The disruption in the blood supply also cuts off the supply of oxygen causing the cells in the brain to die (hypoxic brain damage). In the case of a bleed the flow of blood from the damaged blood vessel into other areas of the brain can also cause direct physical damage (from blood flow or pressure) to structures and cells in those areas of the brain.
Who is typically affected by a stroke?
A stroke can happen to anyone at any time from before birth to advanced old age. Whilst the risk and likelihood of stroke is higher in an older population, 1 in 4 strokes occur in younger or working age people (including children). There is a tendency among medical professionals to refer to brain bleeds rather than strokes particularly when dealing with younger patients who may not then think of themselves as having had a stroke.
What is the Diagnosis and Treatment for a stroke?
The initial symptoms of stroke will vary from person to person and will depend on the area of the brain effected. The main symptoms to watch out for are summarised using the acronym F.A.S.T.:
– has the face dropped on one side? Can the person smile? Has one side or their mouth or one eye drooped?
– can the person lift both arms to the same extent? Do they feel weakness or numbness in one arm?
– is their speech slurred or garbled? Are they unable to talk despite appearing to be awake? Does what they are able to say make sense?
– it’s time to dial 999 immediately if you notice any of these signs or symptoms.
Other symptoms in adults may include: a sudden, very severe headache resulting in a blinding pain; loss of consciousness; complete paralysis of one side of the body; sudden loss or blurring of vision; dizziness; confusion; difficulty understanding or communicating; problems with balance and co-ordination; difficulty swallowing.
Children and Infants
Warning signs of stroke in children may include:
- limb weakness, particularly on one side, which may present as difficulty standing, walking or using the arm or leg, especially on one side.
- excessive sleepiness.
- loss of balance or coordination.
- difficulty seeing or focusing with one or both eyes; parents may notice that one eye is not tracking movement in the same way as the other.
- difficulty vocalising, talking, understanding, and or in older children reading and writing.
- difficulty swallowing including (increased) dribbling or drooling.
- severe or unusual headaches.
- nausea and or vomiting.
- behavioural changes.
- seizure(s) or collapse.
Whilst some of these signs are the same as in adults, children can present differently, for example with fever, headaches or seizures. It is also important to be aware of the physical and visual signs that may occur in young children who are not old enough to effectively communicate the difficulties or symptoms they are experiencing.
In babies stroke will often present in the form of seizures and or extreme sleepiness. Parents may also notice that that their baby is favouring one side of the body or that they are having difficulty moving (or have stopped using) a particular limb.
Early treatment is important both in terms of survival and to help prevent extensive brain damage in stroke survivors. When an ischaemic stroke is detected sufficiently early, drug treatment can help to restore circulation and prevent permanent damage to the brain. In the case of both ischaemic and haemorrhagic strokes, medical or surgical treatment at the earliest opportunity can address the underlying clot or bleed and reduce or limit the brain damage caused. In most cases, the longer a stroke is left untreated the more significant the brain injury is likely to be.
When might there be a clinical negligence claim after a stroke?
Examples of clinical negligence claims involving a brain injury as a result of a stroke may include:
- Failure to diagnose symptoms of an impending stroke and or delays in starting treatment
- Failure to monitor and treat high blood pressure. High blood pressure resulting in damage to blood vessels is the main underlying cause of haemorrhagic stroke. Monitoring and managing high blood pressure effectively is therefore essential to prevent or reduce the risk of a bleed.
- Failure to undertake appropriate investigations such as MRI or MRA scans of the brain can result in delays in diagnosis and treatment during which further brain damage can occur
- Delays in diagnosis or treatment of transient ischemia attacks (TIAs). TIAs or ‘mini strokes’ occur when there is a sudden but temporary or transient disruption in the blood supply to the brain. The symptoms are similar to those of stroke (including speech and visual disturbance and or numbness or weakness in the face, arms and legs), but will resolve within 24 hours (often sooner). TIAs can indicate partial or temporary blockages in the blood supply due to smaller clots or developing obstructions and may be the first warning sign that someone is at risk of a more substantial stroke. Medical research shows that providing a bleed has been excluded implementing anticoagulant drug treatment can prevent an ischaemic stroke.
- Failure to diagnose and treat underlying causes of stroke or TIA such as blood clotting disorders (for example, Factor V Leiden or polycythemia) and thereby prevent or reduce the risk of brain injury from further strokes
- Misdiagnosis including mistaking stroke symptoms for symptoms of mental health problems or for the effects of alcohol, drugs or medication resulting in delays in diagnosis and treatment
Claims from stroke treatment
Brain injury claims may also arise in relation to stroke treatment itself, for example where there are mistakes made during surgical or interventional radiology procedures (e.g. coiling) used to treat bleeds in the brain or in the event of errors with anticoagulant medication.
Whilst a stroke may cause brain damage even with the best possible treatment, delays and failures in the diagnosis and treatment of stroke or underlying conditions can result in more severe and life changing injuries that have a major emotional, practical and financial impact on those affected and their families.
It is important to seek advice from a specialist medical negligence solicitor, experienced in dealing with cases involving stroke who can investigate the matter and advise you or your family on whether to bring a claim against the treating doctors or hospital.
Interested in reading more about clinical negligence claims?
This article has been produced by Catherine Bell of Freeths Solicitors
Catherine Bell is a Senior Associate specialising in brain injury claims as a result of clinical negligence at Brain Injury Group member firm Freeths Solicitors.
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