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Stroke
Stroke is a serious medical condition where the blood supply to part of the brain is
cut off causing damage to that part of the brain from cell death. There are two main
causes of stroke. Ischemic stroke (accounting for over 80% of all cases) occurs
where the blood supply is stopped due to a blood clot or blockage in a blood vessel
leading to or within the brain. Haemorrhagic stroke occurs where there is bleeding
from a blood vessel in the brain or in the space surrounding the brain such as from a
brain aneurysm.
Strokes are medical emergencies as prompt treatment can prevent what could
otherwise be catastrophic brain damage. It is essential for patients who are thought
to be at risk of a stroke to undergo a structured risk assessment for stroke which is
referred to as the ROSIER. The score obtained on this risk assessment determines
the urgency within which the patient is required to be seen and treated by a
specialist service. If an ischemic stroke is detected within 4 ½ hours of onset, it is
able to be treated with thrombolysis which involves the administration of intravenous
Actylase (provided there are no contraindications to its use). Thrombolysis is
directed at breaking down the blood clot causing the blockage and is associated with
a significantly improved outcome in stroke patients.
The Irish Guidelines recommend that all hospitals accepting acute medical
admissions should have onsite or immediate access to a specialist neurovascular
service to assess and to initiate treatment in patients with suspected stroke as well
as having around the clock on-call availability of an acute stroke specialist. Patients
who have experienced significant neurological damage from a completed stroke
often require extensive rehabilitation in a stroke unit in order to recover loss of
function.
Medical negligence claims can often arise where there has been an unacceptable
delay in the recognition and treatment of an impending stroke. There may be an
unacceptable delay in General Practitioners referring patients with symptoms of an
impending stroke for urgent hospital assessment or the Accident and Emergency

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Department of a hospital may fail to adequately and timeously assess a patient’s risk
of stroke and appropriately refer him/her for urgent treatment. After admission, a
Hospital’s medical team may fail to involve a stroke specialist in the patient’s
management at an early stage and thereby miss the limited window of opportunity to
provide thrombolysis. Similarly, the specialist Stroke Team may inappropriately delay
treatment or fail to provide the appropriate treatment. Where there are deficiencies in
the care and management of a patient with overt symptoms of an impending stroke,
a medical negligence claim can lie against your treating practitioners for damages
associated with the consequences of the stroke which would have been avoided had
prompt and adequate medical care been provided.