Strokes: Why time is so critical | Medical Negligence and Personal Injury Blog

Stroke strikes every five minutes. New analysis suggests that the number of people experiencing a stroke will increase by more than 50 percent to 151,000 a year by 2035. Treatments are available, including the ground-breaking mechanical thrombectomy procedure for strokes that are caused by a blocked blood vessel. However, as detailed in updated National Clinical Guidelines, time is the critical factor.

Diagnosis and treatment must be undertaken swiftly. Delays can have a devastating impact – potentially leading to permanent severe brain damage or death. Where negligent delays have led to patients missing the opportunity for ‘game changing’ treatments, legal claims for compensation may be possible.

A stroke occurs when the blood supply to part of the brain is cut off. This can be due to a blockage in a blood vessel (known as an ischaemic stroke) or a bleed in the brain (a haemorrhage).

Symptoms of stroke are captured within the acronym FAST (Facial weakness, Arm weakness, Speech problems and Time to call 999). Other symptoms include headache, vertigo, confusion difficulty swallowing and double vision. Such symptoms can mimic other conditions and this can lead to strokes being misdiagnosed.    

New National Clinical Guidelines for Stroke, published last year, confirm that everyone with stroke symptoms should have a brain scan within one hour of arriving at hospital. Those with a suspected stroke should be admitted to a specialist stroke unit within four hours of arriving at hospital.

Treatment

Treatment for stroke can include thrombolysis, an injection administered to break up a blood clot that is blocking an artery, and thrombectomy, which is an operation to remove a blood clot from an artery in the brain. Both treatments are only suitable where undertaken swiftly.  The guidelines for thrombolysis set out that it should be done as soon as possible (mostly within four and a half hours) and that thrombectomy should usually be undertaken within six hours. Benefits are highly time dependent. According to NHS England, the benefit from mechanical thrombectomy falls by 5.3 percent for every hour of delay.

According to the Stroke Association, thrombectomy can be performed up to 24 hours after a stroke under some circumstances.

The Association has an ongoing campaign, calling on the Government to publish a funded stroke prevention plan to include providing 24-hour access to thrombectomies. It stresses that it is a game changing treatment that needs to be more widely available. The Association previously reported that nearly two thirds of patients were still missing out on this treatment.  

Delays

Delays in the diagnosis and treatment of stroke can occur as a result of medical failings. These may include ambulance delays as well as delays or misdiagnosis in Accident and Emergency Departments. In such circumstances a legal claim for clinical negligence may be possible. However, a particular challenge can be proving that earlier treatment would have altered the outcome. Nevertheless, the situation may be more clear cut where the window for treatments, such as thrombolysis or thrombectomy, was missed as a result of negligent delay.

Causes

Strokes can be caused by various factors including high blood pressure and high cholesterol. Failures in monitoring these, or in prescribing suitable medications, can lead to a legal claim if a patient suffers an avoidable stroke as a result.

Another cause of stroke that we have seen regularly in recent years has been uncontrolled atrial fibrillation (AF). Cases that we have acted in have involved failure by hospitals and GPs to prescribe Non-vitamin K antagonist oral anticoagulants (NOACs) to control atrial fibrillation.  If AF is not brought under control the patient has a risk of forming a clot in their heart which can then travel to the brain and block arteries, causing a stroke. We have written a blog on the link between AF and stroke here.

Prevention of a further stroke

For those who have suffered a stroke, the updated National Clinical Guidelines set out that where high blood pressure is identified, treatment to lower it should start before leaving hospital or at two weeks post stroke (whichever is sooner), as a preventative measure to reduce the risk of a further stroke. With regard to high cholesterol the Guidelines state that everyone should begin treatment with statins before leaving hospital unless there is a medical reason not to do so.

Antiplatelet treatment should be provided to people who have suffered an ischaemic stroke to stop their blood cells sticking together. This should be started as soon as possible within the first 24 hours following a stroke. Those who have had thrombolysis should start antiplatelet treatment after 24 hours.

People who have had a stroke should also be checked for AF.

If the Guidelines were not followed and someone went on to suffer another stroke, there may be a claim for clinical negligence if it can be shown that following the Guidelines would have prevented this happening.

The team at Kingsley Napley are specialists in all aspects of stroke claims including obtaining interim payments to facilitate rehabilitation where possible. Please contact out sensitive team for a no obligation discussion.