Failing To Detect Sentinel Headaches Was Not A Breach Of Duty In A Case Where Subarachnoid Haemorrhage Was Caused By An Expanding Aneurysm

Published date05 October 2020
Subject MatterLitigation, Mediation & Arbitration, Trials & Appeals & Compensation
Law FirmClyde & Co
AuthorMs Joanna Bower

Judgment was handed down on 5 October 2020 by HHJ Cotter QC in the matter of HAC (A protected person by her litigation friend JS) v Ms TH and Dr ALC [2020]: the first trial for NHS Resolution's existing liabilities scheme for general practice (ELSGP).

Background

The claimant, aged 24, suffered a catastrophic subarachnoid haemorrhage ('SAH') on 8 June 2016. It was alleged that there was a failure to elicit the onset of severe headaches preceding the SAH when the claimant attended a nurse (D1) on 19 May 2016 and her GP (D2) on 27 May 2016, such that had she been referred to hospital and undergone neurosurgical treatment prior to the SAH, she would have made a complete recovery.

Quantum was agreed at a capitalised value of '7m in advance of the liability trial on 7 September 2020.

Misdiagnosis of sentinel headaches is relatively common, as the symptoms can present in a similar way to migraines. The claimant's headaches were unilateral and had started around 5 May 2016, over one month before the SAH during which time the claimant was assessed by a number of medical practitioners. In addition to being seen by the defendants on 19 and 27 May, the claimant was also assessed by paramedics when an ambulance was called on 29 May, an OOH GP later on 29 May, and different GPs on 31 May, 3 June and 7 June. They mostly suspected she was suffering from migraines and none of them referred her to hospital. Curiously, the claimant chose neither to pursue the other medical practitioners nor were they called to give evidence at trial.

The key issues for the Judge to consider on breach were:

  1. whether the defendants elicited a history of the onset of headaches and,
  2. if not, would they have been sudden onset (often described as "thunderclap") or gradual; the latter being a question for the neurosurgical experts.

A sentinel headache is a retrospective diagnosis of a headache which precedes a SAH. They are usually caused by (i) a warning leak (a small bleed) or by (ii) aneurysmal expansion. It was not disputed, in this case, that the causal mechanism was slow aneurysmal expansion (not warning leak). The neurosurgeons also agreed that sentinel headaches are usually of sudden onset, but not always.

The facts in this case were of headaches which were atypical of sentinel headaches:

  • they were unilateral not occipital
  • they lasted for a few days before resolving whereas sentinel headaches typically resolve within days if not one day
  • more than 30 days elapsed from the first headache...

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