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Brain Haemorrhage

Brain Haemorrhage

If you or your loved one suffered a subarachnoid haemorrhage but doctors failed to diagnose and treat it in time, you could be entitled to claim compensation. Get in touch with us to find out more.

Brain haemorrhage subarachnoid haemorrhage

There are different types of brain haemorrhage. A subarachnoid haemorrhage is when there is bleeding on the brain, ultimately leading to a stroke.

Subarachnoid haemorrhage is caused by the rupture of an aneurysm in an artery in the brain. Normally the aneurysm gradually increases in size and eventually bursts. In many patients with a subarachnoid haemorrhage there is a history of previous headaches. It is thought this is due to the aneurysm expanding or due to a minor bleed (called a sentinel bleed), both of which occur prior to a major haemorrhage.

Sentinel bleeds

The concept of a sentinel headache is widely accepted. The interval between sentinel bleeds and the major haemorrhage varies considerably. Generally speaking, an interval of four weeks between the first severe headache and the major haemorrhage is entirely consistent with the natural progression of an aneurysm.

In many patients following the initial early bleed, the headache will improve as the bleed is relatively minor and self-limiting.

Managing headaches

Whilst the vast majority of headaches are caused by benign factors such as caffeine, dehydration and muscular tension, such headaches rarely represent suspicious histories, nor do they present any significant findings on examination or investigation. On the other hand, the main causes of sudden severe headache of concern to physicians include vascular and infective causes.

Vascular events tend to be sudden and are frequently instantaneous. The most widely recognised vascular cause of a sudden headache is a subarachnoid haemorrhage.

There is a plethora of other causes of acute headache including migraine, inflammatory conditions, dental causes, ophthalmological causes, systemic illness and injury. This means the history is crucial when assessing patients with headache and with examination and investigation findings it is possible to achieve a timely diagnosis.

Symptoms of a subarachnoid haemorrhage

A 'thunderclap' headache is probably the most obvious sign of a subarachnoid haemorrhage and will be pain unlike anything previously experienced. Other symptoms include:-

  • Stiff neck
  • Feeling/being sick
  • Sensitivity to light
  • Blurred or double vision
  • Confusion
  • Slurred speech
  • Loss of consciousness
  • Convulsions

It is important to note that a patient's headache may improve, but this should not exclude subarachnoid haemorrhage from the list of differential diagnoses. Any patient presenting with the sudden onset of a severe headache mandates consideration of a subarachnoid haemorrhage as the cause for the presentation. A CT scan and lumbar puncture must then be carried out.

Neurological examination

Before proceeding to a CT scan, the medical practitioner may first carry out a neurological examination. However, it must be remembered that patients presenting with a haemorrhage may have a completely normal neurological examination. The index of suspicion for haemorrhage is therefore based on the history of a patient's symptoms, rather than the examination findings.

The absence of any neurological abnormality on examination or improvement in the severity of the headache should not be factors which exclude the possibility of a haemorrhage.

Diagnosing a brain haemorrhage

The presentation of patients to an Emergency Department with the sudden onset of severe headache is a well-recognised area of risk in Emergency Practice. A presentation of this nature would be widely regarded as being indicative of significant neurological event, such as a brain haemorrhage.

A normal neurological examination should not be considered to either reduce the index of suspicion for subarachnoid haemorrhage or be a reliable method of ruling out subarachnoid haemorrhage as the cause for a patient's presentation.

As such, a presentation of this nature requires appropriate investigations with a CT scan being the initial investigation of choice. If the scan is normal, a lumbar puncture should be performed.

The nature of neurological abnormalities found in brain haemorrhages varies considerably depending on the severity and the site of the haemorrhage.

Normal investigations

Only if the CT scan and lumbar puncture are normal can a differential diagnosis be considered for example, a migraine. It would be unsafe and unsound to make such as diagnosis without first investigating the possibility of a brain haemorrhage.

Expected standard of care

Therefore any patient with a severe headache must be investigated for serious underlying conditions, specifically subarachnoid haemorrhage. The absence of neurological deficit or apparent improvement in the severity of the headache would not constitute contraindications to a CT scan being performed.

Indeed, the acute onset of a severe headache is along sufficient to trigger subarachnoid haemorrhage investigations. The question of previous headaches would not detract from this principle.

Thus when a patient presents with a severe headache, the expected standard of care would include the following:-

  • Emergency practitioner to discuss with a more senior doctor in the Emergency Department of the duty Medical Registrar
  • Make arrangements for a CT scan, preferably the same day or the following morning, if a patient presents late at night
  • Admit a patient under the care of the medical team
  • If the CT scan shows no abnormalities, perform a lumbar puncture

If this course of action is not taken, the level of care will be deemed substandard.

Prognosis for a subarachnoid haemorrhage

A subarachnoid haemorrhage is a medical emergency. This means it must be diagnosed and treated quickly if potentially fatal complications are to be avoided.

Sadly, around half of all subarachnoid haemorrhages in the UK are fatal. In some cases, the patient will die instantly leaving no time for medical intervention; in others, medical treatment is delayed, resulting in a fatal outcome.

For those who do survive a subarachnoid haemorrhage, the outcome will depend upon the severity of the haemorrhage and the timeliness of treatment. Unfortunately there may be a degree of disability, both physical and mental. This will differ from patient to patient, but will usually involve:-

  • Muscle weakness and dysfunction
  • Personality and behavioural changes
  • Physical and mental fatigue
  • Decreased social contact
  • Cognitive deficits, including a poor memory
  • Irritability and depression
  • Inability to return to previous levels of employment

Does this amount to medical negligence?

If your loved one has died from a subarachnoid haemorrhage, or has been left with cognitive/physical disabilities, is medical negligence to blame? The answer depends upon whether or not medical practitioners missed opportunities to treat the patient, before a large haemorrhage occurred.

For example, a patient may have sought medical advice for their symptoms prior to suffering a large haemorrhage. Severe headaches and blurred vision are amongst the most common indicators of an impending haemorrhage, yet they can be overlooked by medical practitioners, who instead diagnose a more minor condition such as a migraine.

To ensure a misdiagnosis does not occur, medical professionals must take a full history when assessing a patient with a headache. Patients with a history of red flag symptoms and acute presentations of headache require urgent investigation. The initial screening for virtually all patients with suspected serious causes of headache is CT scanning. This will detect approximately 95% of subarachnoid haemorrhages.

Some aneurysms are seen plainly on a CT scan, while others cannot be seen at all. This is dependent upon the size and position. When the cause of the headache is not evident from the CT scan, doctors should progress to a lumbar puncture. This is particularly because a lumbar puncture excludes infective causes.

If medical practitioners fail to achieve this standard of care, thereby failing to prevent a major haemorrhage, there will be grounds for a medical negligence claim.

On the other hand, if a major haemorrhage occurs without a patient having previously sought medical advice, medical error cannot be to blame.

Claiming for medical negligence

If you suspect you, or your loved, has the grounds for a medical negligence claim, you need to speak to a solicitor as soon as possible. When looking for a law firm to contact, be sure to choose one which not only offers a free initial consultation, but also specialises in clinical negligence claims. This is evidenced by their accreditation for example, if their lawyers are on the Law Society Clinical Negligence Panel, you can be assured of their expertise.

When you contact a solicitor, you will be asked about the care provided and the injuries incurred. After taking all the details, a solicitor will consider your case before suggesting whether or not you are eligible to pursue litigation.

If there is a case to be answered, you will be asked whether or not you would like to proceed with a claim. If the case involves a deceased relative, you will be able to make a claim on their behalf. Should you choose to continue, your solicitor will begin the claims process, and will handle your case for the duration.

The first step will be to obtain your medical records. You will also be asked to provide a witness statement. From there your solicitor will explain each stage, guiding you through the process.

Funding a clinical negligence claim

There are different ways of funding a medical negligence claim. Legal aid is no longer available in clinical negligence cases, with the exception of catastrophic birth claims (such as cerebral palsy). The two most common funding methods are:-

1. No win no fee

No win no fee is the most popular funding method. The agreement known technically as a Conditional Fee Agreement (CFA) means that your solicitor will not get paid if you lose. Your claim will be underwritten by an insurance policy and this will cover any other costs that you incur, such as the other side's fees. The insurance policy is self-insuring, meaning it pays for itself.

If you win, your costs will be paid by the other side. Your solicitor is entitled to a success fee, and due to legislative changes introduced in April 2013, this must now be deducted from your compensation settlement. Nevertheless, success fees are capped at 25% of the damages, so your compensation will only ever be reduced by a quarter.

2. Legal expenses insurance

Legal expenses insurance (LEI) is a policy often added on to other types of insurance, such as home insurance. Your solicitor will ask you to check whether or not you have LEI. You may need to contact your insurer to make sure, as many people are not even aware they have such a policy.

If you do have legal expenses insurance, this may cover the cost of legal action.

Time limits

Clinical negligence (medical negligence) claims must be made within three years of the negligent incident. The date by which your claim must be made is called the date of limitation. If you exceed the date of limitation you will not be able to pursue litigation, even if you have a very strong basis for a claim.

To ensure you do not miss the chance to claim compensation, it is important to contact a lawyer without delay. Even if you seek advice months before the date of limitation, it may be that there is not enough time to begin a claim, as the process can take a number of years to complete.

If more time is required, it may be possible for your solicitor to agree an extension. There are also some exceptions to the three year rule. Where the Claimant lacks mental capacity, there will be no time restrictions. If the Claimant was under the age of 18 when the negligence happened, he/she will have until their 21st birthday to bring a claim. Lastly, if the Claimant was not initially aware of the negligence, it may be possible to rely on a later date of knowledge.

Compensation for medical negligence

If your claim is successful, you will be awarded compensation. This redress is intended to reflect the physical, emotional and financial damage you have sustained. Those claiming for brain haemorrhage negligence have often suffered severe injuries, while most are unable to return to work. Therefore the compensation settlements in such claims are normally very high.

Contact us today

To make a claim for a brain haemorrhage, please get in touch with us today. We specialise in clinical negligence law and will be able to advise you further.

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