Subarachnoid Haemorrhage – what is it and do I have a claim?

Swift diagnosis and treatment of a Subarachnoid Haemorrhage (SAH) is vital otherwise the consequences can be devastating. The nature of the condition is such that it can be misdiagnosed or not managed in time. In these instances, there can be a claim for medical negligence and compensation may be obtained to help survivors face a better future. We specialise in SAH claims.

What is Subarachnoid Haemorrhage?

SAH is a type of stroke caused by bleeding on the brain that is often the result of a ruptured intracranial aneurysm (a bulge in a blood vessel). It is a life-threatening condition.

Why a brain aneurysm develops is not entirely clear according to the NHS but some risk factors are known including high blood pressure, a severe head injury and autosomal dominant polycystic kidney disease.

Subarachnoid Haemorrhage presents as a sudden severe headache, often referred to as a ‘thunderclap headache’, typically alongside vomiting and photophobia. These symptoms are often caused by a minor initial bleed – called a sentinel bleed.

Generally, a CT scan can diagnose SAH. If this is inconclusive a lumbar puncture may be needed.  Surgery to repair / secure the source of the bleeding may be required. There are two main surgical techniques – coiling and clipping. The former uses tiny coils to fill the aneurysm so that blood cannot enter it, sealing it off from the main artery. The latter uses a clip to seal the aneurysm. Such procedures are usually performed by an interventional neuroradiologist.

Complications of Subarachnoid Haemorrhage

A potentially very serious complication of SAH is that the brain aneurysm bursts again, having sealed itself, which is generally referred to as a rebleeding. The risk of rebleeding is greatest in the few days immediately following the first bleed and carries a high risk of permanent disability or death. As a result, repair of an aneurysm is required urgently.

According to the British Medical Journal, early diagnosis and surgically securing the aneurysm within 48 hours are associated with a lower risk of rebleeding and lower disability.

A further possible complication, most common a few days after the first haemorrhage, is vasospasm or delayed cerebral ischemia, which is a narrowing of the blood vessels due to spasming. This lowers the supply of blood to the brain, causing brain damage. There are treatments which can prevent vasospasm, including a medication called nimodipine.

Hydrocephalus, a build up of fluid on the brain leading to increased pressure, is common after SAH and can cause brain damage. This is because the problems caused by the haemorrhage can disrupt the production and drainage of cerebrospinal fluid, CFS, which supports and surrounds the brain and spinal cord. This can result in more fluid around the brain. A lumbar puncture can be used to treat hydrocephalus.

SAH can cause long term consequences, including problems with cognition, memory and concentration, depression and epilepsy. Recovery from SAH can be a slow and frustrating process and help may be required from a number of specialists including, rehabilitation specialists, occupational therapists, physiotherapists, neuropsychologists and speech and language therapists.

 

Do I have a claim?

If Subarachnoid Haemorrhage was not properly diagnosed or treated then there may be a claim for medical negligence.

Claims relating to SAH often occur as a result of misdiagnosis, for example the symptoms are mistaken as a migraine or neck pain. Claims also arise from delays in treatment - usually due to failure to prioritise the patient or the lack of out of hours / lack of weekend staff. It may be that a medical professional does not identify the signs that a person may be suffering from SAH and as a result they go on to have a catastrophic second bleed.

We have acted in cases in which theatre lists have not been rearranged to prioritise SAH cases, meaning that non-urgent elective procedures have gone ahead of more urgent patients, sometimes with catastrophic results.

In some cases, GPs have misdiagnosed the condition and in others the errors have been committed by neurologists.

Claims can also arise where SAH is missed on a brain scan because the scan is misreported or due to delays in obtaining a scan in the first place. If there was a failure to provide medication such a nimodipine to prevent vasospasm then this might result in a claim. Errors could also occur during repair surgery. 

If there has been a failure in the management of blood pressure which led to SAH then, again, there may be a claim. 

To be successful it must be proved that the medical care provided was below a reasonable standard and that this caused injury.

 

Case studies – cases undertaken by our team

1. Failure to recognise sentinel bleed symptoms and refer to hospital for several weeks by a GP leading to catastrophic brain injury – compensation £4 million.

2. Failure of a private neurologist to refer to hospital leading to a 7-day delay in treatment and secondary major bleed - compensation £6 million.

 

Obtaining compensation

Compensation can be awarded to cover the needs of SAH survivors both past and future. This may include the cost of care, aids and equipment and private therapies. Damages may also be recovered for any loss of earnings and for pain and suffering. If the person no longer has capacity to manage their affairs then the costs of a Court of Protection Deputy may be included. If a claim is being brought for the death of a loved one by their dependents, then the award could include sums for a loss of dependency on that person both financially and emotionally.

How we can help

Our solicitors have experience in dealing with a wide range of brain injury claims including those for SAH. We are well versed in the complexities that present themselves in these cases. We work with leading experts from brain surgeons to rehabilitation specialists and case managers and obtain excellent outcomes for our clients, supporting them through the process of a claim and focussing upon their future needs. Our specialist Court of Protection team can also assist where a client needs a Deputy.

FURTHER INFORMATION

If you have any questions regarding this blog, please contact James Bell or a member of the Medical Negligence and Personal Injury Practice, or call us on 020 7814 1200.

 

ABOUT THE AUTHOR

James Bell is the head of our Medical Negligence and Personal Injury practice and joined the firm in 2023 from Hodge, Jones & Allen. He has undertaken medical negligence cases for over 20 years.  Throughout his career James has dealt with a very wide range of cases concerning all types of negligence claims – delayed diagnosis cases, birth injuries, anaesthetic injuries, surgical errors,  GP and hospital negligence, all types of orthopaedic claims, including complex hip and knee replacement surgery claims and and all types of cancer cases.