An Ischaemic Stroke: Was it Avoidable?

An Ischaemic Stroke: One Woman’s Story

In a recent reported legal claim, a patient sought damages after a failure to diagnose signs of a coming stroke. The claim was not successful, but it does show the importance of being attentive to warning signs of stroke.

The patient went to a walk-in centre at her local community hospital with her partner in 2011. She complained of a painful right hand and wrist. She saw a nurse practitioner who thought she had tendonitis (inflammation of the tendon), and he gave her a splint and prescribed painkillers.

The next day she suffered a headache and then collapsed. She was taken by ambulance to hospital, where she was found to have left hemiplegia (paralysis down one side). Investigations showed that she had suffered an ischaemic stroke (a clot had blocked the blood supply to the brain). This had damaged part of the brain (the right basal ganglia). She then underwent treatment to break up and then remove the clot (thrombolysis and thrombolectomy) but was left very disabled. She is still paralysed down one side and has lost some vision. She has to use a wheelchair and rely on others for personal care.

Was the Nurse Negligent?

The patient’s claim was that at the community hospital nurse was negligent and ignored symptoms which suggested a vascular problem – something disrupting the blood supply to her hand. Because of her condition, she was not able to give evidence herself but her partner did. On her case, the nurse had only taken a superficial history and ignored important symptoms of coldness and a blue discolouration in her hand. It was claimed on her behalf that she should have been referred to a doctor and treated with heparin, an anticoagulant (a drug to prevent clotting). This would have avoided her stroke.

The judge preferred the nurse’s evidence to that of the woman’s partner. He found that the nurse took a thorough history and that neither the woman nor her partner mentioned coldness or discolouration. There was therefore nothing to suggest a vascular problem (blood supply disruption) or developing ischaemia (lack of blood supply).

However the case raises some interesting issues.

Critical Limb Ischaemia

Firstly, sudden onset ischaemia is very serious. Here it was said to have been an indication of a coming stroke, but in other cases it can be sign that leads to amputation. The signs of critical limb ischaemia are said to be the 5 “p’s”: pain, pallor (pale colour), paraesthesia (numbness/altered sensation), paralysis and lack of pulse. Some add a 6th which is perishing cold.  It was claimed that this woman had 3 of the p’s: pain, pallor and coldness. It is very important that patients with these symptoms are treated quickly.

Strokes: The Warning Signs

Secondly, strokes sometimes come with warning signs, and it is important to heed the warning. It may be that this woman’s stroke in fact did not. But there are many cases where people go to hospital with symptoms such as a sudden severe headache or weakness down one side but those symptoms then pass off. The fact that the person seems to get better could be misleading, and there have been cases where medical staff have failed to investigate when they should have paid more attention to warning signs. A CT scan may for instance have shown a bleed or a blockage which could have been treated to prevent a serious disabling stroke.

Claims for Damages

Where people have suffered avoidable injuries as a result of negligence, they are entitled to damages. These are specialist claims and it is important to have the right legal advice. If you would like advice about a possible claim, please telephone 0800 044 8488. Our experienced lawyers are expert in handling claims for people who have suffered serious harm from avoidable strokes.