Michael Boylan LLP secured €500,000 in damages for a client who suffered neurological deficits as a result of the delayed diagnosis of atlanto-axial joint instability.
Our client had a long history of rheumatoid arthritis and was under the care of a Dublin-based hospital. Following an assessment in 2001 a consultant suggested cervical x-rays in light of restricted cervical and lumbar spine movement. Unfortunately, those x-rays were not carried out.
In late 2010 she presented to an emergency department with a three-day history of headaches and vertigo. A CT brain scan was reported as normal at the time; in fact it demonstrated atlanto-axial joint pathology and instability. She continued to suffer headaches, vertigo and neck and shoulder pain in the years that followed; no further investigations were carried out. In our view these symptoms were indicative of cervical spine disease.
In late 2017 she developed severe vertigo and was admitted to hospital. Following further imaging and a neuroradiology multidisciplinary meeting in early 2018, it was concluded that posterior circulation brain changes were stroke lesions possibly due to vertebral artery compromise. After a further severe vertiginous episode in early 2019 she was transferred to a consultant neurosurgeon. MRI of the cervical spine confirmed basilar invagination with kinking of the medulla and CT confirmed significant arthritic changes at C1/C2. A C1/C2 fusion was performed and the severe vertiginous episodes ceased.
Our client was left with neurological deficits, including memory and language impairment, and MRI lesions consistent with strokes apparently caused by long-standing atlanto-axial joint instability. It was our position that if the appropriate investigations and diagnosis had been made earlier, particularly in 2001 when cervical spine x-rays had been recommended but not performed, monitoring and earlier intervention would have prevented the neurological sequelae.
Liability and causation remained in issue throughout proceedings in what was a complex case. The action settled for €500,000 together with all legal costs, immediately prior to the hearing date.