Subarachnoid Haemorrhage Misdiagnosis Claims

Understanding Subarachnoid Haemorrhage (SAH) and the Warning Signs

To understand if negligence occurred, we must first look at the medical reality of the condition. A Subarachnoid Haemorrhage is a type of stroke caused by bleeding on the surface of the brain. It occurs in the subarachnoid space,the area between the brain and the tissues that cover it.

What is a subarachnoid haemorrhage?

In the vast majority of cases, this bleeding is caused by a ruptured cerebral aneurysm (a ballooning weak spot in a blood vessel). When this vessel bursts, blood flows into the space around the brain, increasing pressure rapidly and damaging brain cells.

While the medical term is complex, the mechanism is simple: a vessel bursts, and the resulting pressure is catastrophic. You may often see the term spelled as "hemorrhage" in international medical journals, but in Irish hospitals and legal documents, it is referred to as a haemorrhage.

This is not a condition that "gets better" on its own. It requires immediate surgical intervention (such as coiling or clipping) to stop the bleeding and prevent a second, often fatal, rupture.

The "Thunderclap Headache" and Red Flags

The hallmark symptom of an SAH is the "Thunderclap Headache." This is not a normal tension headache or a migraine.

Patients almost universally describe it as being hit on the back of the head with a cricket bat or a sudden, blinding pain that peaks within seconds. It is frequently described as the "worst headache of my life."

For a doctor in A&E or a GP surgery, this description alone should trigger immediate alarm bells. However, the headache is rarely the only sign. It is often accompanied by distinct red flags:

• Neck Stiffness: An inability to touch the chin to the chest due to irritation of the corridor spinal fluid.
• Photophobia: An intense, painful sensitivity to light.
• Nausea and Vomiting: Sudden sickness that often accompanies the headache.
• Visual Disturbance: Double vision or blurred sight.
• Collapse or Seizure: A loss of consciousness, however brief.

Many patients experience a sentinel bleed (a minor warning leak) days or even weeks before the major, catastrophic rupture. This warning leak causes a sudden headache that may ease off, leading patients to believe they are fine. If a patient presents to a doctor during this "warning" phase, it is a golden opportunity to save a life. Diagnosing the leak allows surgeons to repair the aneurysm before the massive rupture occurs. Missing this opportunity is a frequent ground for medical negligence claims.

How SAH Is Missed in A&E and General Practice

Despite the severity of the condition, Subarachnoid Haemorrhage is frequently misdiagnosed. Because the symptoms can mimic more common, benign conditions, inexperienced or overworked staff may fail to investigate further.

The "Migraine" Misdiagnosis

The most common failure we see is the dismissal of an SAH as a migraine or a tension headache.

Doctors must take a thorough history. There is a distinct difference between a migraine (which usually comes on gradually) and a thunderclap headache (which is instantaneous).

• If a patient over 40 presents with a "first-time" severe headache, SAH must be ruled out.
• If a patient with a history of migraines says "this feels different," that statement must be taken seriously.

Negligence often occurs when a doctor assumes the diagnosis is a migraine without performing the necessary physical checks or scans to rule out the life-threatening alternative.

Failure to Investigate

There is a clear standard of care in Ireland for investigating a suspected SAH. If a patient presents with a sudden-onset severe headache, the protocol is specific:

1. Urgent Non-Contrast CT Brain Scan: This should happen immediately. A CT scan is very good at spotting fresh blood, but it is not perfect. If the scan is done more than 6 hours after the headache started, the blood may have started to dissipate, making it invisible on the scan.
2. Lumbar Puncture (if the CT is clear): If the CT scan is clear, but the symptoms persist, the doctor cannot rule out SAH. They must proceed to a Lumbar Puncture (spinal tap). This test looks for xanthochromia (a yellowing of the spinal fluid caused by the breakdown of red blood cells).

Negligence often arises when a doctor relies solely on a "clear" CT scan and sends the patient home, failing to perform the essential Lumbar Puncture.

System Failures: Discharge and Communication

Sometimes the failure is administrative or communicative rather than clinical.

• Premature Discharge: Patients are sent home with painkillers and told to sleep it off.
• Lack of Safety Netting: Patients are not given clear "return immediately if..." instructions.
• Junior Doctor Errors: A junior doctor in A&E may fail to escalate a complex case to a Consultant or Senior Registrar, resulting in a lack of senior review.

Proving Medical Negligence in SAH Cases

Medical negligence is a complex area of Irish law. It is not enough to show that a mistake was made; we must prove that the mistake caused the injury.

The Legal Test: Duty, Breach, and Causation

To succeed in a claim, we must satisfy the legal principles established in the landmark case of Dunne v National Maternity Hospital. In plain English, we must prove three things:

1. Duty of Care: That the doctor or hospital owed you a duty of care (this is automatic in a patient-doctor relationship).
2. Breach of Duty: That the medical care you received fell below the standard expected of a reasonably competent medical professional. We must prove that no other competent doctor of the same status would have made the same mistake.
3. Causation: This is often the most critical factor. We must prove that if the diagnosis had been made earlier, the outcome would have been different.

For example, if a "warning leak" was missed on a Monday, and the catastrophic rupture happened on a Friday, we argue that competent care on Monday would have led to surgery that would have prevented the Friday rupture entirely.

Who Is liable? (Public vs. Private Care)

• Public Patients (HSE): If the negligence occurred in a public hospital, you generally sue the Health Service Executive (HSE). The State Claims Agency handles the defence through the Clinical Indemnity Scheme. You are not suing the individual doctor personally, but rather the system that employed them.
• Private Patients: If you were treated by a consultant in a private capacity or at a private hospital, the claim may be directed against the consultant personally (covered by their medical indemnity insurance) or the private hospital.

Our team has extensive experience dealing with both the State Claims Agency and private medical indemnifiers.

Time Limits and the Legal Process in Ireland

In Ireland, the Statute of Limitations for medical negligence is generally two years minus one day.

However, the clock does not necessarily start on the day the misdiagnosis happened. It starts from the "Date of Knowledge." This is the date you first realised (or should have realised) that:

1. An injury had occurred.
2. The injury was significant.
3. The injury was attributable to the act or omission of the medical provider.

For example, if a misdiagnosis occurred in 2023, but you only discovered that the scan was misread after a review in 2024, the two-year clock might start from that date in 2024. Determining this date is legally complex, so immediate legal advice is essential.

Why Medical Negligence is Excluded from the Injuries Resolution Board

You may have heard of the Injuries Resolution Board (formerly PIAB), which handles car accidents and workplace injuries.

Medical negligence claims are specifically excluded from the Injuries Resolution Board.

Because these cases involve complex questions of liability and causation requiring expert medical reports, they must be managed through the court system (usually the High Court for serious injuries). This does not mean every case goes to trial,the majority are settled through negotiation or mediation,but the process is different from a standard personal injury claim.

Investigating Your Claim: What Happens Next?

If you believe you have a case, the process begins with a thorough investigation. You do not need to face the medical establishment alone.

The Investigation Phase

When you instruct Michael Boylan LLP, we take the burden of investigation off your shoulders.

1. Retrieving Records: We will take up all relevant medical records, including A&E notes, GP records, and most importantly, the radiology imaging (CT/MRI scans).
2. Expert Analysis: We send these records to independent experts in the UK. This usually includes a Consultant Radiologist (to check if the scan was misread) and a Consultant Neurosurgeon (to comment on the treatment you should have received).
3. Establishing Breach: If these experts confirm that the care was substandard, we proceed to issue proceedings.

Preparing for Your First Consultation

Meeting a solicitor can feel daunting, but our goal is to make it as comfortable as possible. To get the most out of your first meeting, it is helpful to bring:

• A rough timeline of events (dates of hospital attendance, what was said).
• Copies of any discharge summaries or letters you have.
• A list of current medications and ongoing symptoms.

Common questions to ask us:

• "Do the independent experts think I have a strong case?"
• "How is the case funded?" (We will explain the costs structures transparently, adhering to Law Society regulations).
• "What support is available for my rehabilitation while the case is ongoing?"

Frequently Asked Questions

Can a CT scan miss a subarachnoid haemorrhage?

Yes. While CT scans are highly effective, their sensitivity drops as time passes. A CT scan performed more than 6,12 hours after the onset of the headache may fail to show blood. This is why a Lumbar Puncture is mandatory if the CT is clear but the clinical history suggests an SAH. Failing to perform this second test is a common ground for negligence.

Can I claim on behalf of a family member who has passed away?

Yes. If a loved one died due to a missed diagnosis, the family can bring a Fatal Injury Action. This can provide financial security for dependents (statutory solatium and loss of dependency). We understand this is an incredibly difficult time, and we handle these cases with the utmost sensitivity.

How long does a medical negligence claim take in Ireland?

These are complex cases. A typical timeline is 2 to 4 years, depending on whether the HSE or insurer admits liability early. If they deny liability, it may take longer to reach a conclusion. However, we work tirelessly to move your case forward efficiently.

Why Michael Boylan LLP?

When dealing with a catastrophic injury like a subarachnoid haemorrhage, experience is both an asset and a necessity.

Michael Boylan LLP is recognised as a leader in medical negligence litigation in Ireland. We specialise in holding the medical system accountable. We have successfully concluded many high-profile cases involving missed brain haemorrhages, securing the care and compensation our clients need to rebuild their lives.

We combine forensic attention to detail with a compassionate approach, ensuring you feel supported at every step of this challenging journey.

Take the Next Step

If you suspect that a missed diagnosis has changed your life or the life of a loved one, please do not suffer in silence. We are here to listen and to advise.

Contact our specialist team today to arrange a confidential discussion about your circumstances.

*In contentious business, a solicitor may not calculate fees or other charges as a percentage or proportion of any award or settlement.