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Posted on 2nd May 2017

Misdiagnosis of Brain Injury and Clinical Negligence Claims

Brain injury is a complex area of medicine where symptoms often overlap between discrete types of injury making diagnosis difficult. Sometimes referred to as the “hidden epidemic”, sufferers often experience symptoms that significantly disrupt their life, but go unnoticed by medical professionals for various reasons.

In fact, since diagnosis is so difficult, brain injury is sometimes referred to as the “hidden disability” because lots of brain injury sufferers experience symptoms that significantly disrupt their life, but go unnoticed for various reasons.

When misdiagnosis, delayed diagnosis or missed diagnosis happens the individual may be able to make a medical negligence claim. This guide looks at the frequency of misdiagnosis, why it happens, what types of brain injuries are commonly misdiagnosed and what you can do about it if it happens to you or your loved one.

Definitions:

There are two general terms used to describe brain injury and there are some controversies over the exact definition of each term. Some people use the terms interchangeably, but most organisations have started to recognise discrete differences between Acquired Brain Injury (ABI) and Traumatic Brain Injury (TBI).

Broadly speaking, ABI is the overall umbrella term for all types of brain injury. TBI is a sub-type of ABI and describes a specific injury caused by an external force to the head by a fall, assault or road accident, for example. Other sub-types don’t really need a term equivalent to TBI because they are things like stroke or hypoxia and already have a medical term to describe them. TBI is used to group together particular external traumas. Unfortunately, because TBI and ABI are such similar terms this has led to some confusion.

Though other illnesses can harm the brain, they are generally not considered brain injury because the approach to treatment will be very different. The shared characteristic that brain injuries have is that they can be treated and improved through things like rehabilitation, physiotherapy and cognitive treatments rather than treatments such as medication alone.

The majority of associations and organisations align themselves with the following definitions of ABI and TBI:

Acquired Brain Injury (ABI): An injury caused to the brain that has been acquired after birth that is not related to a congenital defect. Causes include (but are not limited to) infection, toxic exposure, a fall, a car accident or a stroke.

A traumatic brain injury is a type of ABI.

Traumatic Brain Injury (TBI): A brain injury caused by a trauma to the head like a fall, an assault or a road accident will count as a TBI. An injury caused by illness like a stroke or brain haemorrhage will not count as a TBI. There must be an external force that has caused the injury for it to be classified as TBI.

Severity of Injury:

According to Headway, severity of brain injury is established according to the following conditions:

  Loss of Consciousness Post-Traumatic Amnesia
Minor brain injury Under 15 mins Under 1 hour
Moderate brain injury 15 mins – 6 hours 1 hour – 24 hours
Severe brain injury 6 hours – 48 hours 24 hours – 7 days
Very severe brain injury Under 48 hours Under 7 days

How often does misdiagnosis happen?

Brain injury is a broad term covering a lot of different injuries, so the rates of misdiagnosis vary according to the specific injury a patient has (or is diagnosed with). Brain injuries of all kinds can be difficult to diagnose because the symptoms are often very similar to other ailments, and it can take a brain scan to prove an injury has occurred. However, there are instances where injury won’t show on a scan.

According to one study that looked in to the rate of missed diagnosis of traumatic brain injury in patients who’d received a diagnosed of spinal cord injury, 58.5% of TBI diagnoses were missed, which is high.

Anecdotal evidence indicates that missed diagnosis of mild brain injury is quite common.

Why does it happen?

Brain injury is sometimes called the “hidden disability” because it often goes undiagnosed, especially if it’s relatively minor. According to Headway, minor brain injuries can get missed because:

  • There’s usually no external sign of injury
  • There was no loss of consciousness and the person may not have attended A&E
  • The symptoms can overlap with other conditions, such as depression or other pre-existing mental health issues
  • Other, more immediately serious injuries have occurred
  • The person was under the influence of alcohol or other substances at the time of injury which can mask symptoms
  • If caused by a traumatic event, like an assault or road accident, symptoms may be attributed to a stress reaction or post-traumatic stress disorder

Mild and moderate injuries can be missed because imaging scans don’t pick up on all brain injury, so an MRI or CT scan can appear clear when damage is present.

What are the consequences?

Often mild and even moderate brain injuries clear up on their own, with symptoms decreasing over time. Symptoms of moderate brain injury can persist for up a year, sometimes more, so a lack of diagnosis in these instances can have major consequences.

Brain injury can cause difficulties with the following cognitive tasks:

  • Thinking
  • Attention
  • Organising
  • Concentration
  • Word-finding problems

These issues can cause worry and anxiety, especially when they go undiagnosed. Increased anxiety about these symptoms often makes them worse leading to a vicious cycle where symptoms do not clear up. It can affect ability to work, personal relationships and even personal care.

What are some commonly misdiagnosed brain injuries?

Mild injuries like post-concussion syndrome

The effects of concussion are technically called post-concussion syndrome. Symptoms include:

  • Headaches
  • Dizziness
  • Nausea
  • Sensitivity to light and noise
  • Sleep disturbance
  • Memory problems
  • Irritability
  • Restlessness
  • Impulsivity
  • Poor concentration
  • Feeling depressed, tearful or anxious
  • Fatigue
  • Difficulties thinking and problem-solving

Most concussions clear up on their own within two weeks of the injury. However, in some cases the symptoms persist for much longer. It’s normally in these cases that misdiagnosis or missed diagnosis happens. When scans do not show evidence of injury, GPs can assume patients are experiencing hypochondria as a result of the trauma of their original concussion, or sometimes diagnose people with mental health problems instead of a concussion.

Encephalitis

Encephalitis is an auto-immune disease that was only identified in 2007. It has symptoms including paranoia, mania, personality changes and catatonia and can be misdiagnosed as a mental health disorder. This is especially worrying since research indicates that the disease is fatal in 25% of cases, so an early diagnosis is incredibly important.

Hydrocephalus

Hydrocephalus has symptoms including difficulty walking, bladder and bowel incontinence, confusion, poor co-ordination and drowsiness. Since it can seem like a sufferer is reverting back to infancy it’s often misdiagnosed as dementia, Alzheimer’s or Parkinson’s. This is because nearly all those affected are over the age of 55.

Carbon monoxide poisoning

Carbon monoxide poisoning is particularly hard to diagnose because symptoms are broad ranging and non-specific. Often carbon monoxide poisoning can be confused with flu-like symptoms. This means missed cases are likely to be common, especially in cases where exposure is relatively low, but consistent over a long amount of time (known as chronic exposure).

Cerebral Palsy

There are a number of considerations a doctor needs to take into account before they make a diagnosis of cerebral palsy – one major factor is timing. An early diagnosis can lead to successful early intervention but it makes it more likely that your child will be misdiagnosed. Early diagnoses often lead to altered relationships between parents and child.

cerebralpalsy.org summarises the issues surrounding timing of diagnosis as follows:

    • Early diagnosis – Early diagnosis can lead to early intervention, treatments, therapies, funding and benefit programs. It can result in misdiagnosis.
    • Delayed diagnosis – A delay in diagnosis can allow time for the family to bond before the condition is known. It allows time to observe developmental milestones, rule out other conditions, and confidently confirm cerebral palsy.
    • Misdiagnosis – Misdiagnosis can occur if signs are not properly monitored, tested, and confirmed. Or, when other conditions aren’t ruled out properly. The diagnosis of cerebral palsy may be correct, but the severity, extent, or co-mitigating factors may be improperly diagnosed.

Find out more about cerebral palsy and negligence claims on our cerebral palsy page.

How do you know if you’ve been misdiagnosed and what can you do about it?

Part of the reason brain injury is considered a complex part of medicine is because it’s so difficult to diagnose, and there’s no way to establish 100% certainty that you’re experiencing a brain injury without evidence, which has to be gathered and analysed by a medical professional. Most doctors would probably dispute that a diagnosis can be made with total certainty.

Ultimately, a misdiagnosis comes down to your own sense of whether you feel the doctors have got something wrong. There is nothing wrong with trusting your own instinct and at least getting a second opinion. If you do think you’ve been misdiagnosed Headway offer the following advice:

  • Keep a notebook on your person and note down symptoms as you experience them. Include detailed descriptions of how they feel, the time of day you experience them and how long they go on for.
  • Take this notebook with you to show your GP.
  • Ask if you can be referred to a neurologist for further tests.

Can you claim for it?

Yes, in some instances you can claim for misdiagnosis of a head injury. Your solicitor must prove that negligence has happened. A doctor may not be found negligent if they have missed your brain injury, even if it has caused you harm. That’s because, since brain injury is hard to diagnose, it may be deemed reasonable that the doctor missed the condition you have.

To find out more about how a case for clinical negligence is put together read our article How Do You Prove Medical Negligence Claims?

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