Risks relating to neurological spinal and brain injuries
RISKS RELATING TO NEUROLOGICAL SPINAL AND BRAIN INJURIES
Neurosurgery is the medical speciality concerned with prevention, diagnosis and treatment of disorders which affect any portion of the nervous system, to include the spinal cord and brain. Whilst the vast majority of patients benefit hugely from advances in this field of medicine, unfortunately mistakes can be made at a number of stages from the initial diagnosis through to post operative care.
A neurosurgeon has a duty to act with all reasonable skill and care in order to ensure that a patient does not suffer from an injury as a result of negligence.
1. This duty of care can arise in the following circumstances:
There is a duty of care on the part of the doctor to select the right patient for the right operation.
An example would arise in circumstances where a patient has lumbar difficulties but perhaps does not require invasive surgery. The doctor recommends surgery which unfortunately results in very significant injury to the patient such as Cauda Equina Syndrome.
2. There is also duty for a doctor to ensure that a patient is examined appropriately.
An example would include circumstances where a doctor fails to examine a loss of sensation/numbness in the genital/perianal regions in a patient with a back injury. The patient subsequently develops complete Cauda Equina. In this situation had the doctor identified the sensory loss then one would have expected an immediate MRI scan would have been arranged and the patient would have been treated for a central disc prolapse prior to the onset of incontinence and loss of sexual function.
3. There is also a duty of care on the part of the doctor to arrange for appropriate
imaging such as MRI scans on the part or of parts of the spine which are
relevant taking into account the clinical history and findings on examination.
An example of a failure on the part of the doctor could arise in circumstances where a patient has fallen and sustained spinal cord compression, unbeknownst to the doctor as appropriate imaging is not conducted. The patient is encouraged to move and the spinal cord is severed, resulting in paraplegia.
Another example of this would be where an individual sustained a sporting injury, such as a rugby injury, and complains of neck pain. Imaging is taken on a part of the spine which shows no abnormality. The patient is discharged and subsequently develops paraplegia. Further X-rays taken show a fracture dislocation in an area of the spine which was not X-rayed. Had appropriate imaging been taken the fracture dislocation would have been identified, diagnosed and treated and the patient would have been neurologically intact.
It is imperative that appropriate imaging is taken of the spine where the injury has occurred. This should not necessarily be specific to one part of the spine as in high velocity injuries such as a high speed road traffic accident, 15% – 20% of patients have more than one spinal fracture.
A doctor also has a duty to achieve the correct diagnosis without delay. A misdiagnosis can result in very serious neurological complications, to include paraplegia.There is naturally a better chance of Neurological improvement if patients are treated early and this is particularly relevant with regards to Cauda Equina cases.
The doctor also has a duty to ensure that treatment is not delayed after an initial diagnosis.
An example can arise in circumstances where there is a diagnosis of Intracranial Aneurysm and subsequently there is a delay in treatment or perhaps no treatment is provided. The patient then suffers another bleed resulting in severe neurological deficit.
Treatment of Aneurysmal Subarachnoid Haemorrhage where the patient is Grade 1 is associated with moderate to good recovery in 90% of patients. Quite often in circumstances where an accident has occurred and where the patient has suffered a neurological injury then communication can be difficult. Doctors are required to take extra care to ensure that they exclude a spinal injury and possible head trauma.
Injuries can also occur during operations as whilst patients may be asked to consent to the possibility of spinal cord injury or brain injury prior to an operation, they do not consent to negligence on the part of their doctor. A doctor has a duty to operate competently and to perform the surgery with reasonable skill and care.
Post operative management is also critical for a doctor to consider as there is a duty to recognise increased post operative systemic problems such as low blood pressure. There is also duty of care to repeat imaging if the patient is neurologically worse post operatively as a doctor may have inadvertently damaged a major blood vessel and failed to recognise this during the surgery.
The examples referred to above represent situations that can and have arisen resulting in a claim for medical negligence as a result of injury caused to the patient.
If you require further information please contact Rachael Liston, Partner on:
Tel.: +353 1 637 6200