This is an action for damages for clinical negligence. C pursues a claim arising from the death of his wife W who died on 4th August 2018 after suffering a cerebral venous sinus thrombosis. The central allegation is that her condition was misdiagnosed as an arterial ischaemic stroke. It is further alleged that this erroneous diagnosis led to W being given alteplase (thrombolysis), a “clot-buster” drug, instead of heparin, an anticoagulant. C alleges that, if W condition had been correctly diagnosed and properly treated, she would have made a good recovery. D denies breach of duty. It says that the diagnosis (whilst seen to be incorrect in hindsight) was a reasonable one to make at the time and the treatment was therefore appropriate. [1]
W was born on 1st April 1959 [3]
On 15th July, a Sunday, W woke as normal but at 08.30 she developed sudden onset speech disturbance and right sided weakness. [14]
W was taken to hospital. [15]
At 10.12 a head CT scan was carried out – Conclusion – No acute intracranial abnormality [20]
From 10.43 W was treated for a presumed left middle cerebral artery ischaemic infarct by intravenous infusion of alteplase. [25]
W condition deteriorated… A repeat CT head was undertaken at 12.09. Conclusion: Bilateral hemorrhagic foci in the apex of the parietal lobes. The possibility of an SVT has been raised with the team. CT venogram advised. [26]
A CTV was undertaken almost immediately after the CT report at 12:32 [28]
The CTV was reported at 13:24 PROVISIONAL CONCLUSION: Probable superior sagittal sinus thrombosis. [29]
no active management was planned. Heparin, despite being the preferred treatment for CVST, was not given at this stage. …there were concerns that it could exacerbate the haemorrhage. [32]
Heparin was commenced on 19th July. [33]
I reject all the allegations of breach of duty and this claim will be dismissed [94]
I find on the balance of probabilities that the extent of the thrombus was at all times extensive; that heparin had no material effect when administered for five days; that alteplase contributed to the haemorrhage; that haemorrhage did not cause or contribute to W death; that her death was caused by infarction secondary to CVST; and that W would still have died even if CVST had been diagnosed promptly and she had been given heparin, not alteplase, on 15th July. [135]
I have found on the facts that, on the balance of probabilities, the alleged breaches (if established) did not cause or contribute to W death. She would not have survived, even if there had been no breach of duty. [137]
I conclude that: a. there was no breach of duty on the part of D’s treating clinicians; b. if C had established a breach of duty on the part of D, such breach of duty did not cause or contribute to W death. [138]
the claim is dismissed [139]
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