Case Study: Incorrect Diagnosis of Cauda Equina Syndrome

Compensation: £640,000

JMW has secured £640,000 for a man who was left with life-changing disabilities that could have been prevented if doctors had correctly diagnosed cauda equina syndrome.

Jim was a 40 years old lorry driver. He had an attack of sciatica while lifting boxes at work. He went to his local casualty Department where he was examined and advised to rest and take pain killers as needed until the pain wore off.

Jim rested up but the pain got worse rather than better and he requested a home visit from his GP. As well as the worsening back pain the GP also noted numbness across his waist and scrotum, a loss of sensation to pass urine, no bowel movement for 4 days and an inability to walk without collapsing.

As these symptoms were highly suggestive of cauda equina syndrome (CES) the GP sent Jim to hospital by ambulance with a letter for the hospital staff listing her findings and suggesting a possible diagnosis of cauda equina syndrome.

Jim was examined at the hospital fracture clinic but the doctor did not perform a full neurological examination. Jim was catheterised and sent for an immediate MRI scan.

Unfortunately, Jim could not tolerate the MRI scanner as he was in such intense pain when lying on his back and felt claustrophobic inside the machine so the scan was aborted and he was told that a CT scan would be performed instead.

Jim was then admitted to the ward where he was seen by the registrar who performed only a limited neurological examination.

Jim remained in hospital and was wrongly told to walk around This may have made his condition worse.

A few days later Jim awoke to find that he had been incontinent of urine.

Eventual diagnosis

Later that day Jim had numbness in both feet and was dribbling urine. There was also reduced anal tone and some faecal incontinence. A diagnosis of cauda equina syndrome was made and Jim was persuaded to undergo an MRI scan, which was performed the same day. This showed a giant disc prolapse at L4/L5 level. Emergency, difficult and lengthy decompression surgery was undertaken, 3 1/2 days after the initial diagnosis of cauda equina syndrome had been made by the GP.

Lasting effects

Jim was left with persistent pain in his left leg, worse at night, and numbness in both feet; something he finds very unpleasant particularly when it is accompanied by shooting electric shock-like pains. He is not fully continent of urine and his sexual function has also been affected. He is chronically constipated and was not able to return to work.

The claim

On Jim’s behalf, we argued that the hospital was negligent in not fully recognising and appreciating all the ‘red flag’ signs of cauda equina syndrome he was displaying when admitted to hospital and delaying in arranging a scan which meant his operation was delayed

Time is of the essence in treating someone with suspected cauda equina syndrome and we argued that Jim would have made a good recovery and his problems he now suffers from would have been less severe and disabling.

Settlement

JMW were able to win £640,000 in compensation for Jim.

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