STROKE MEDICAL NEGLIGENCE FAILURE TO IDENTIFY STROKE IN A&E 

John Whelan Solicitor with specialist expertise in Stroke Medical Negligence gives an example of failure to identify stroke in A&E.   

An example of a case of Failure to Identify Stroke in A&E.  

Here’s an example of a case where a stroke was not identified in A&E, leading to delayed treatment and significant consequences:

Case Example: Failure to Identify Stroke in A&E

A Patient with no significant medical history, suddenly experiences dizziness, nausea, difficulty walking, and mild confusion.      The Patient also feels some weakness in the left arm and leg. Concerned, the Patient’s husband drives the Patient to the A&E.

A&E Visit:

a) The Patient arrives at the A&E within an hour of the onset of her symptoms. The Patient reports dizziness, nausea, and trouble walking, but she conscious and able to answer questions.  The Patient’s husband mentions that she has been slurring her speech slightly.

b) Initial Assessment: The A&E physician performs a quick physical exam but does not conduct a detailed neurological assessment.  Vital signs are normal except for slightly elevated blood pressure (140/85 mm Hg).

c) The physician considers several possible diagnoses, including vertigo or migraine, given the Patients dizziness and nausea. Based on the mildness of her symptoms and her relatively young age, stroke is not immediately suspected.

d) No CT scan or other brain imaging is ordered, as the physician attributes the Patients symptoms to a less urgent cause (vertigo or anxiety). The Patient is given anti nausea medication and fluids and told to rest.

Progression of Symptoms:

a) After a few hours in the A&E, the Patients symptoms worsen. The Patient now has more pronounced weakness on left side, is slurring speech significantly, and appears confused. The Patients husband insists that something is seriously wrong.

b) A nurse performs a more thorough neurological check, recognising the possibility of a stroke, and alerts the A&E physician. A CT scan is finally ordered, but it is now almost six hours since the onset of the Patients symptoms.

Diagnosis and Treatment:

a) The CT scan reveals an ischemic stroke affecting the posterior circulation, specifically the cerebellum and brainstem, which explains her dizziness, nausea, and difficulty walking.

b) Because more than 4.5 hours have passed, the Patient is no longer eligible for tPA (tissue plasminogen activator), a clot-busting drug that could have significantly improved the chances of recovery.

c) Thet Patient is admitted to the stroke unit for supportive care and rehabilitation, but the delay in diagnosis has caused irreversible damage.

Outcome:

a) The Patient survives the stroke but suffers from permanent left sided weakness (hemiparesis), difficulty with balance and coordination (ataxia), and persistent speech difficulties (dysarthria).

b) The Patients recovery is slow, and she requires extensive rehabilitation. With timely treatment, particularly if tPA had been administered within the critical window, the outcome could have been much better.

Important Points of the Case:

1. Failure to Recognise Stroke Symptoms.
2. No Timely Imaging.
3. Missed Treatment Window.

For more detailed insights into how Stroke Medical Negligence and Patient Safety impacts you and how Whelan Law can support you, please visit our Patient Safety Rights Legal Advice https://www.whelanlaw.ie/news/stroke-medical-negligence-claims-what-you-need-to-know/