Stroke Medical Negligence Patient Safety Mismanagement of Hemorrhagic Stroke

Stroke Medical Negligence Patient Safety Mismanagement of Hemorrhagic Stroke 

John Whelan Solicitor with specialist expertise in Stroke Medical Negligence gives a case example of Mismanagement of Hemorrhagic Stroke.

Case Example: Mismanagement of Hemorrhagic Stroke

A Patient presented to A&E with a sudden severe headache, vomiting, and difficulty speaking.  The Patients family reported that the Patient had been hypertensive for years but was not consistently following the Patients prescribed medications for high blood pressure.   The Patient had no prior history of stroke.

Initial Assessment:

a)       Upon arrival, the Patient was conscious but confused, with a high blood pressure reading of 210/120 mmHg.   The Patient also had a GCS (Glasgow Coma Scale) score of 14, which indicated a mild level of impairment.

b)       The A&E team suspected the Patient might be suffering from a hemorrhagic stroke due to the Patients symptoms and history of uncontrolled hypertension.

c)       An urgent CT scan of the brain was ordered to confirm the diagnosis.

Diagnosis of Hemorrhagic Stroke:

The CT scan revealed a large intracerebral hemorrhage (ICH) in the right frontal lobe. There was significant brain swelling and evidence of midline shift, which indicated increased pressure in the brain and a serious risk of further brain damage or herniation.

Initial Mismanagement:

1. Failure to Manage Blood Pressure Appropriately:

a)       Given the high blood pressure, the emergency team recognised the importance of controlling the Patient’s hypertension to prevent further bleeding and brain damage. However, no clear blood pressure management protocol was followed in the first few hours.

b)      The Patient was treated with oral antihypertensives rather than intravenous medications which are more effective in rapidly lowering blood pressure in acute hemorrhagic stroke cases. Oral medication could have been too slow and unreliable in this critical setting.

c)       The Patient ‘s blood pressure remained high for several hours, and the delay in achieving adequate blood pressure control put the Patient at risk for continued bleeding and worsening brain swelling.

1. Failure to Assess and Treat Elevated Intracranial Pressure (ICP):

a)       Despite signs of brain swelling and a midline shift on the CT scan, the hospital team failed to promptly assess and treat elevated intracranial pressure. There was no discussion of ICP monitoring or measures to reduce intracranial pressure.

b)      As a result, the brain continued to swell, further compressing the brain tissue and leading to worsened neurological deficits (e.g., more profound speech difficulty, confusion, and loss of consciousness).

1. Delay in Neurosurgical Consultation:

a)       The stroke team did not promptly consult with a neurosurgeon to discuss the possibility of surgical intervention (e.g., evacuation of the hematoma or decompressive craniectomy). Although surgery is not always required in hemorrhagic stroke, the significant size of the hemorrhage and midline shift warranted earlier discussion of surgical options.

b)      The decision to delay surgery allowed the bleeding to continue and the brain swelling to worsen.

1. Inadequate Monitoring and Follow-up Imaging:

The Patient’s condition continued to deteriorate, but there was a failure to order a follow-up CT scan after 6-12 hours to assess the progression of the bleeding. Follow up imaging could have informed a more timely intervention if there had been an increase in hemorrhage size or worsening of the midline shift.

Outcome of Mismanagement:

a)       By the time a neurosurgical consult was requested 24 hours later, the Patient had developed worsened neurological symptoms, including loss of consciousness and respiratory compromise.

b)       A repeat CT scan showed increased bleeding and greater midline shift. At this point, the brain herniation had started to occur, and the Patient was transferred to the ICU for intubation and sedation.

c)       Surgical intervention (decompressive craniectomy) was finally performed, but the delay in addressing the Patients intracranial pressure and bleeding left the Patient with significant, permanent brain damage.

d)       The Patient developed severe motor and cognitive impairments and was unable to return to her baseline level of function.   The Patient was eventually transferred to a long term care facility for ongoing rehabilitation and support.

Important Points of the Case:

1. Failure to Rapidly Control Blood Pressure.

2. Failure to Address Elevated Intracranial Pressure (ICP).  

3. Delayed Neurosurgical Consultation.

4. Inadequate Monitoring and Follow Up Imaging.

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/