Difficulties managing cavernoma – do you have a legal claim?

I represent clients who have suffered brain injuries due to negligent medical treatment, or following accidents that were not their fault.  With cases involving medical negligence, I often represent clients who have suffered conditions that impact the brain which are not always widely known.  One such condition I have come across, which is not very well known, is cavernoma.

What is a cavernoma?

Cavernomas (also knowns as cavernous malformations, cryptic angiomas or cavernous haemangiomas) are a cluster of abnormal blood vessels which can be found anywhere in the brain or spine.  A typical cavernoma resembles a raspberry [NHS], and can vary in size from a few millimetres to several centimetres. 

Often, a cavernoma does not cause any symptoms and may go unnoticed for most of (or even all of) a patient’s life.  However, when symptoms do occur, they can be very serious.  They can include:

• Haemorrhage (bleeding)
• Seizures (fits)
• Headaches
• Tiredness
• Weakness
• Memory problems
• Difficulty concentrating
• Numbness
• Dizziness/balance issues
• Slurred speech

Cavernomas can also cause an individual to suffer a stroke, and this was, sadly, the case for a client I represented.

Each case is different and the severity of symptoms depends largely on the location of the cavernoma.  Serious problems tend to occur when the cavernoma is pressing on certain areas of the brain or is bleeding into it.  In most cases, bleeding is small and may not cause symptoms.  However, severe haemorrhages can be life threatening and may lead to long-term brain damage.

It’s not clear what exactly causes a cavernoma, but it is thought that in a minority of cases the condition is genetic.  In most cases, cavernomas seem to occur completely at random.

In the UK, it is estimated that one in every 600 people has a cavernoma.

Diagnosing cavernoma

Cavernomas are most commonly diagnosed on MRI scanning, as this is the imaging type with the highest sensitivity for detecting them.  A CT scan or angiography can also be used to diagnose cavernoma, but neither of these are as reliable as an MRI scan.

Because the majority of people with cavernomas do not have symptoms, they are mostly found following a scan carried out for another reason.

Bleeding risk

One of the biggest concerns with cavernoma is the risk of bleeding.

Almost always, cavernomas are associated with evidence of a previous bleed.  Most patients diagnosed with cavernoma will therefore have suffered some bleeding before.

In patients who have never had a previous major bleed, the annual risk of bleeding appears to be very low, at less than 1%.  However, in patients who have previously suffered a haemorrhage, the risk of bleeding is significantly higher (at between 4-25% each year).

Management of cavernoma

Given the increased risk of bleeding in those with a history of haemorrhage, it is crucial that the cavernoma is managed appropriately.  A further bleed on the brain could have a catastrophic impact on a patient and has the potential to cause significant brain damage.

Treatment for cavernoma includes the following:

• Watch and wait: this is where doctors will arrange for regular check-ups to monitor the situation.  This is generally the preferred option if a patient is showing no symptoms and the cavernoma does not look to be causing any harm.

• Neurosurgery: surgery to remove the cavernoma can be carried out under general anaesthetic, although this is not without risk.  Many factors need to be considered when determining whether to surgically resect a cavernoma.  One of the most important factors is the location of the cavernoma.  If it is superficial and easily accessible, then the risk of serious complications following surgery is very low.  When balanced with the higher risk of re-bleed, doctors may take a view that the risks of surgery are significantly outweighed by the benefits.

• Stereotactic radiosurgery: less-invasive surgery may be preferred where cavernomas are located deep in the brain and invasive surgery is very high risk.

Negligence and cavernoma

There are many different ways in which treatment involving cavernoma may have been negligent and I’ve considered the most common of these below.

• Delayed diagnosis

Because cavernoma does not cause symptoms in many patients, it is often the case that it goes unnoticed until an MRI scan has been performed for another reason.  However, there can still be instances of negligent delays in diagnosis – including where a patient has shown symptoms but has not been referred for the appropriate imaging, or where a scan has been incorrectly reported.

If your diagnosis of cavernoma was delayed, you may have a claim for compensation.

• Inappropriate management/treatment

In some cases, cavernoma will require surgery under general anaesthetic.  Errors during surgery can cause catastrophic injuries to a patient and these could give rise to a legal claim.

Where surgery is required but has been delayed or not carried out at all, this can also lead to serious injury to a patient.  This is what, unfortunately, happened to my client, who went on to suffer a haemorrhagic stroke following diagnosis of a symptomatic cavernoma.  The medical experts we instructed in his case found that urgent surgery should have been performed to remove the cavernoma, but his doctors instead decided to take the “watch and wait” approach.  As a result of his stroke, my client suffered a range of physical and cognitive injuries. 

If you sought medical treatment for symptoms of cavernoma and your condition deteriorated due to a failure to offer treatment, I would suggest seeking legal advice as you may have a claim for compensation.

How compensation can help?

Clients who succeed in claims for brain injury due to cavernoma can recover compensation not only for the pain, suffering and financial losses caused – but also to cover their future needs, including:

• Treatment/therapy costs
• Care needs (including assistance with childcare, gardening etc.)
• Adaptations to existing home, or new (more suitable) housing
• Aids and equipment
• Travel expenses

Although no amount of money can ever undo the distress caused by a serious injury, compensation can certainly make a difference in improving a person’s quality of life.