Our client presented to A&E with what was described as a ‘worst ever’ headache. After being assessed, she was discharged with painkillers. Her condition deteriorated over the next couple of days and an ambulance was called.
While in the ambulance on the way back to the same hospital, our client lapsed into a coma. At the hospital she underwent a CT scan which revealed an ‘acute stroke secondary to acute intracerebral bleed’. Our client was transferred to a tertiary hospital for the evacuation of the intracerebral haematoma. She made a reasonable recovery but was left with a permanent visual impairment, some sensitivity, neuropathic pain and cognitive blunting.
The allegations of breach of duty were: failing to obtain a competent history; failing to ascertain and record the severity of the pain; failing to ascertain and record the speed of onset of the headache; failing to carry out a competent examination; failing to consider or act upon a differential diagnosis of a vascular intracerebral cause given the history; failing to carry out a CT head scan and discharging her home.
Breach of duty was subsequently admitted.
The case on causation was that, had a CT scan been undertaken and the bleed diagnosed, our client would have been referred to a neurological unit and undergone surgical evacuation of the bleed before her decompensation and collapse, thereby avoiding permanent injury. Primary causation relating to the hemiparesis was conceded, but the extent of causation was denied. Ultimately, terms of settlement were agreed by way of negotiation.