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Part 2 Recognising the Potential Existence of Brain Tumours in Children and the Implications from a Medical Negligence Perspective

View profile for Kimmo Boote
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To read part 1 of the article please click here.

Raised intracranial pressure

Raised intracranial pressure may present with vomiting, headache and altered level of consciousness. This can be due to the tumour itself, but more commonly due to the system that conducts cerebrospinal fluid (CSF) around the brain. If the tumour totally or partially obstructs the conducting system, then these symptoms may arise.

With very raised intracranial pressure, the blood pressure may be elevated, the heart rate lowered and when the back of the eye is examined, papilloedema may be seen. Papilloedema occurs when the part of the back of the eye that is in contact with the CSF is pushed forward by virtue of the increased pressure. In infants where the fontanelle is not closed, (the soft spot on top of the head), it may be tense indicating raised intracranial pressure.

Legal implications
 

Delays in the diagnosis often relate to failures by clinicians to link the symptoms that may be associated with a brain tumour and the signs being presented by the patient. It is important to determine if delay led to harm that could have been prevented by earlier diagnosis.

The red flags listed above include specific and non-specific features that can be used to look at the patient’s clinical course. Any case of a claim regarding a brain tumour should be examined to see if there were opportunities for earlier intervention, and whether or not that by making the diagnosis at that stage would have had an impact on the patient’s subsequent outcome. The type of tumour, its histological features (and degree of maturation, and how aggressive it is), its location, and its local and distance effects, and any associated co-morbidities or syndromes may impact on whether or not any delay would have affected the final outcome.

Some cases will involve such aggressive tumours not amenable to therapy from the time that any symptoms were in place, or that the tumour’s location was such that inevitable progress would have occurred whatever treatment was given. In other words, correctly diagnosing and treating the tumour at an early stage would not have led to a different outcome to a belated diagnosis and treatment.

If you want further information about this particular topic, or wish to discuss the possibility of bringing a claim, please contact the Dutton Gregory Clinical Negligence Team on (01202) 315005, or email k.marden@duttongregory.co.uk