Delay in Treatment Causes Severe Vision Impairment in Teenager

Lanyon Bowdler acted for a minor in a clinical negligence claim against the Plymouth Hospital NHS Trust. The claim arose out of a delay in diagnosing and treating intracranial pressure caused by venous sinus thrombosis between August 2008 and December 2008. As a result the claimant suffered bilateral impairment of vision and a left divergent squint requiring surgery. She also required a lumbar peritoneal shunt which caused on-going symptoms of dizziness and fatigue.

The claimant was 16 years old at the time of the negligence and had just started an apprenticeship at a local nursery as a nursery nurse. Throughout year 11 at secondary school the claimant had complained of headaches with vomiting, tinnitus in one ear and diplopia. Initially her symptoms were treated as migraine.

A CT scan on 27 August 2008 was reported as normal. She continued to suffer with symptoms which became more severe and on 2 October 2008 she was referred to the Royal Eye Infirmary because, in addition to the headaches which had become more severe, her vision had deteriorated and the GP suspected benign intracranial hypertension. She was transferred to the Derriford Hospital Neurology Department and a further CT scan on 3 October 2008 demonstrated no change since the previous one and she was discharged home on 7 October.

She was seen again in the neurology clinic on 14 October and 11 November 2008. On 19 November she was re-admitted with further visual deterioration. An MRI scan on 27 November demonstrated superior sagittal venous sinus thrombosis and a lumbar drain was inserted though removed on 1 December. She remained very ill in hospital during this period and her vision deteriorated further. She did not undergo the insertion of a lumbar peritoneal shunt until 16 December 2008.

The xlaimant’s case was that with appropriate management by the Trust an MRI scan should have been performed by 5 October 2008 and this would have led to the diagnosis of a venous sinus thrombosis and raised intracranial pressure.

The defendant admitted that there was a failure to treat the claimant’s intra-cranial pressure effectively and on the balance of probabilities, if she had been treated appropriately, she would have had normal acuity with slightly reduced vision field on the right and very slightly reduced visual field on the left.

The claimant’s case was that with timely treatment with anticoagulation and acetazolamide this would have been sufficient to adequately reduce the intracranial pressure, and hospital admission would have been limited to less than three weeks.

The claimant would not have required insertion of a lumbar-peritoneal shunt and she would not have developed a squint. She would have had normal visual acuities, visual field, colour vision and quality of vision in her right eye, and normal visual acuities, slightly impaired visual field and mildly impaired colour vision and quality of vision in the left eye.

As such the claimant is restricted in terms of self-care, employment and many other aspects of daily living and requires on-going support.

The case was settled five days before the trial for £1 million. This was a global settlement and included compensation for pain and suffering, loss of earnings, care, aids and equipment and adaptations to property.