The Claimant, a 70 year old man, received £300,000 for a stroke suffered after Trust’s failure to diagnose stenosis of his carotid artery. His mobility was severely limited and his reliance on the use of a wheelchair was expected to be permanent - A v Queen Elizabeth Hospital NHS Trust 09.12.09

On 23 August 2005 the Claimant, who was 65 years old, attended the accident and emergency department at a hospital of the Defendant trust, complaining of headaches, recurring numbness and paraesthesia in his left leg and hand. He was assessed, diagnosed as suffering from mononeuropathy, was given a neurology outpatient appointment and was discharged from hospital. However, the Claimant’s symptoms persisted and on 7 September he was taken back to hospital. He was admitted and was diagnosed as suffering from neuropathy. The following day the Claimant was reviewed by a consultant physician who considered that the Claimant might be suffering from an upper neurone lesion. A cranial CT scan was sought and physiotherapy was provided. Two days later, the Claimant's limb weakness in his left arm and left leg became worse.

On 12 September 2005, the Claimant was assessed by a locum consultant neurologist who diagnosed him as showing signs of the cerebral shock phase of an acute stroke, which it was believed he had suffered on, or after, 9 September. After being diagnosed, the Claimant was given aspirin therapy and scan results showed infarct in the right anterior cerebral territory, occlusion of the right internal carotid artery and stenosis of the left internal carotid artery.

There was some loss of mobility in the Claimant’s left arm but he regained some power in his right arm. His left leg was too weak for him to be independently mobile and he was heavily dependent on a wheelchair and required adapted accommodation and daily care. He also suffered depression. The Claimant was able to cope with daily activities such as washing, toileting and dressing and did not require 24 hour assistance. He was, however, according to the experts, unlikely to make any significant further recovery from his neurological and psychological injuries.

Allegation:

The Claimant alleged negligence in (1) failing to recognise on 23 August that his symptoms were consistent with recurrent transient ischaemic attacks; (2) failing, on 7 September, to include recurrent transient ischaemic attacks in the diagnoses; (3) failing to arrange for Doppler/Duplex scanning to be carried out urgently; (4) failing to promptly diagnose the stenosis of his right internal carotid artery; (5) failing to prescribe aspirin until September 12; and (6) failing to provide a timely cranial CT scan.

The Claimant alleged that if, on 23 August, staff had recognised that his symptoms were consistent with recurrent transient ischaemic attacks, a scan would have been carried out promptly, the stenosis would have been diagnosed and there would then have been sufficient time to organise the removal of the obstruction before he suffered the stroke.

Admission:

The Defendant admitted that the diagnosis on 23 August should have included transient ischaemic attacks; a cranial CT scan should have been ordered. It was further admitted that failure to prescribe aspirin between 7 and 12 September and the delay in carrying out a scan after admission on 7 September amounted to substandard care.

The estimated amount for PSLA was £35,000.

Comment:

Given the Department of Health’s current campaign to increase public awareness of the symptoms of actual and impending stroke, it is important hospital Trusts also improve their systems for investigating suspicious symptoms of stroke. The Claimant was clearly within a demographic at risk and his symptoms warranted further investigation. Adoption of a care pathway within the accident and emergency department may have prevented this diagnosis being missed.