Natasha Richardson Dies After Brain Injury
Brain Experts Weigh In on Natasha Richardson's Head Injuries From a Skiing Accident
By Miranda Hitti
WebMD Health News
Reviewed by Louise
Chang, MD
March 18, 2009 -- Actress Natasha Richardson, 45, has died in the wake of head
injuries she sustained in a fall at a Canadian ski resort.
Media reports have posted a statement from Richardson's family that reads,
"Liam Neeson [Richardson's husband], his sons, and the entire family are shocked
and devastated by the tragic death of their beloved Natasha. They are profoundly
grateful for the support, love, and prayers of everyone, and ask for privacy
during this very difficult time."
According to media reports, Richardson's accident, which
happened Monday on a beginner slope at Canada's Mont Tremblant ski resort,
didn't result in immediate, obvious harm. Richardson is said to have felt fine
until an hour or so after the fall, when she developed a headache.
At that point, she went to a hospital near the Canadian ski resort where she
was staying and was later transferred to a New York hospital. Richardson and
Neeson have two sons.
WebMD talked with three brain experts, none of whom treated Richardson, about
her brain injury. The interviews were conducted before Richardson's death was
announced.
What would account for a delayed reaction after a fall?
There are at least two possibilities.
First, a pre-existing condition could be exacerbated by the head injury, says
Jordan Grafman, chief of the cognitive neuroscience section
at the National Institute of Neurological Disorders and Stroke, part of the National Institutes
of Health. It's not known if Richardson had any pre-existing brain conditions.
Second, a fall could jar the brain inside the skull.
"If the brain moved quickly, it could cause contusions [and] bleeding, and
the bleeding could lead to increased intracranial pressure, and that could have
severe consequences," Grafman tells WebMD.
That bleeding may take time to cause obvious problems.
"Sometimes, the bleeding and the increase in pressure are delayed," Grafman
tells WebMD.
Neurologist Russell Packard, MD, agrees.
"You could get what's called a subdural hematoma -- the injury starts with
some slow bleeding and so you seem fine at first, and then, within an hour or
two hours ... the start of a headache," Packard tells WebMD.
Packard is the former head of the headache and head
injury clinics at Texas Tech and the University of North Texas. He is now in
private practice in Palestine, Texas. He's a fellow of the American Academy of
Neurology and the American College of Physicians.
A hematoma is a blood clot that's growing, says Jill Bolte Taylor, PhD, a
brain scientist who had a stroke at age 37 and wrote a book -- My Stroke of
Insight -- about it.
"The problem with any kind of blood clot is that you have a fixed and rigid
size of the bone. And, so if you've got blood accumulating somewhere, getting
bigger and bigger, it has to push against whatever else is in there, which
stunts and traumatizes the cells so that they can't function," Taylor tells
WebMD.
"The first thing that the body does anywhere there's trauma is send more
blood in order to bring the immune system, so the immune system can make an
assessment and clean up what it needs to clean up. The same thing is true inside
of the brain. So now, not only is there a bleeding into the brain region, but
more blood is wanting to get there in order to bring the immune system in order
to clean it up," Taylor explains.
"At this point, the brain's in trauma and as long as the cells are
essentially swimming in a pool of blood, they cannot perform their function,"
Taylor says.
How long can that delay last?
Symptoms of brain injury may take an hour or two, or perhaps longer, to
develop.
"If something bad is going to occur, it's almost always within the first 24
hours," Grafman says. "That's why anybody who's had any kind of a head injury
should be watched closely ... certainly for the first 24 hours, and should
almost always go see a doctor," Grafman says.
How rare is a serious traumatic brain injury?
As a rough estimate, there are "probably at least a
million head injuries per year in the United States. Probably 80% or more are
mild sort of dings you might get playing football or something of that nature, or a slight fall," says
Grafman, who has studied brain injuries for nearly 30 years.
"The overwhelming majority of those people who have that kind of very mild
head injury are going to recover nicely, either very quickly or certainly with
six to nine months," Grafman says.
Does everyone need an MRI or CT brain scan
after a head injury?
Probably not.
"I think most people would say that's probably overkill, since the kind of
situation that happened to [Richardson] is relatively rare," Grafman says. "If
you have symptoms ... then it's likely somebody would have a scan. But if
somebody is apparently symptom-free after a ding, it's not likely they would
have a scan."
Doctors would also perform a neurologic exam, checking on the patient's
mental status and whether they're confused or sleepy, as well as investigating
their symptoms.
What are the symptoms of a brain injury?
Grafman's list of brain injury symptoms includes
headaches, nausea, general
malaise and discomfort,
seizures
, changes in thinking, changes in memory, and
changes in attention or other mental skills.
"All those kinds of things are usually not too subtle if
there's a big problem that needs intervention," Grafman says. "For a milder head
injury that might cause some subtle symptoms, as often as not, CT scan or MRI is going to be
negative. You're not going to see anything" on the brain scan, he says.
After a fall -- even a little tumble -- make a point to be around other
people.
"You don't want to isolate yourself," Grafman says. "You want to be around
other people who can see how you're doing."
Grafman isn't trying to be alarming. "I don't think there's any reason to be
excessively nervous," he says. "Don't be alone after something like that
happens, but you don't necessarily have to run to the ER unless you experience
changes."
Taylor also encourages people not to let someone who's
just had a head injury go to sleep.
"That's very important, because if they do go to sleep, they can slip into
unconsciousness, and nobody's watching closely for various types of neurological
symptoms," Taylor says.
"If there are neurological symptoms or discomfort or headache, don't be
afraid to call 911," Taylor says.
If there is bleeding in the brain, what can doctors do
about it? Is surgery an option?
"It depends," Packard says. "If there's just a small amount, they're usually
admitted [to the hospital] and just watched."
"If there's a really large blood clot that's pressing on the brain and it
looks like it might be expanding, that's a neurosurgical emergency," Packard
says.
Packard points out that the bleeding doesn't necessarily happen in the area
where someone hits their head.
"A lot of times, people fall and hit the back of their head, but because the
brain moves inside the skull ... back and forth, you can actually have bleeding
in the front part of the brain," Packard says.
Richardson reportedly wasn't wearing a helmet at the time of her skiing
accident. Would a helmet have made a difference?
Maybe.
Grafman recommends wearing a helmet during any activity that could lead to a
head injury. "A helmet is usually not going to make a head injury worse,"
Grafman says. "It can help prevent more serious trauma, particularly when it's
due to some sort of blunt injury."
Taylor agrees. "I think that the precautions that we do take are really worth
the effort," she says.
Packard says he doesn't believe helmets should be mandatory for skiers, "but
it certainly would make sense to protect your head." He points out that skiing
isn't as risky as football, riding motorcycles, or boxing, in terms of head
injury risk.
Packard and Grafman say that Richardson could still have had a brain injury
even if she had been wearing a helmet.
"It could have happened, yes, because of the rotational forces in the brain,"
Grafman says.
"Helmets can make a difference with any kind of head injury, but ... people
can get injured even with the helmet," Packard says.
SOURCES:
Associated Press.
People.com.
The New York Times.
Jordan
Grafman, PhD, chief of the Cognitive Neuroscience Section, National Institute of
Neurological Disorders and Stroke, National Institutes of Health.
Russell Packard, MD, Palestine, Texas.
Jill Bolte Taylor, PhD, author, My Stroke of Insight; neuroanatomist, Midwest Proton Radiotherapy Institute.
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