Actress Natasha Richardson's death puts spotlight on head injuries

Diana Rossetti

Bump, bonk, fall or complete knockout.

When it comes to head injuries, experts say you can’t be too careful, especially with warmer weather starting to lure more people outside.

Shock over the death of 45-year-old actress Natasha Richardson after a fall on a beginners’ ski slope has put the spotlight on head injuries.

What can happen

No blood. No loss of consciousness. No complaints of pain. Richardson was later taken to her hotel where it was reported an hour later that her condition had begun to deteriorate.

Early news reports speculated about the cause using terms such as “traumatic brain injury,” “talk and die” or “talk and deteriorate.”

An autopsy Thursday showed Richardson bumped her head in the fall, causing an epidural hematoma — bleeding between the skull and the brain’s covering, according to wire reports.

“In the neurosurgical realm, the ‘talk and die’ or ‘talk and deteriorate’ usually means an epidural hematoma,” said Henry Bartkowski, director of pediatric neurosurgery at Akron Children’s Hospital in Akron, Ohio.

Caused by an injury to one of the arteries at the dura — the tough, leathery covering around the brain — an epidural hematoma may not cause symptoms until enough blood has gathered to cause pressure.

Since it involves arteries, “the blood can gather fairly rapidly and cause ‘talk and deteriorate’ approximately 15 percent of the time. If an adult or child suffers a head bump, they just may have a mild headache, but a short time later, there could be worsening headache, nausea and vomiting. That’s when you seek medical care and a CT scan. The results may necessitate surgery,” Bartkowski said.

There’s typically little direct brain injury, but the expanding blood clot causes symptoms later.

Adults, the surgeon said, usually suffer another type of injury — subdural hematomas, which result in blood gathering under the dura and middle layers of the brain covering. This occurs when the brain is shaken during a severe fall or during a bicycle or automobile accident.

“Then you have venous (vein) bleeding plus an injury to the brain and the symptoms are almost immediate,” he said.

Injuries to children

Bartkowski said epidural hematomas occur more frequently in children than adults.

“We had a girl who was riding her bike with no helmet. She fell, bumped her head but felt fine. She went home and told her sister, but they did not want to bother her mother at work until she started getting a bad headache with nausea and vomiting. Fortunately, her mother was proactive, brought her in and we took out a huge epidural hematoma. That’s why we so strongly advocate helmets for Rollerblading, skateboarding, bicycling, skiing and horseback riding.”

With any head injury, the patient should be checked regularly for a worsening headache, nausea, vomiting or changes in alertness, he said, which would call for immediate transport to a hospital emergency facility.

School principals, such as Benny Griffiths at Northwood Elementary School in North Canton, Ohio, are no strangers to assessing students with head injuries. Griffiths maintains a stringent edict that any head injury be reported to him.

“I don’t care if a child falls in a classroom, on the playground, in phys ed, the gym, wherever, I come and actually examine the injury,” said Griffiths, a coach who has completed Red Cross first aid and CPR training.

“Then the parents are called and they have the option of coming in. If it is a severe head injury, we immediately call 911 along with a phone call to the parents. Kids can be sent to our clinic maybe daily and we take every one of them seriously. We also keep documentation of the injury in our medical log. I’d rather err on the side of safety.”

Aneurysm considered

Dr. David L. Gormsen, Mercy Medical Center’s chief medical officer, is a veteran emergency room physician who has seen his share of head injuries during a 30-year career.

If the details of Richardson’s fall are accurate and she had no pre-existing condition, he said such incidents are rare.

“From my perspective to have this very unusual circumstance, I wonder if she had an aneurysm (a weakening in the wall of a blood vessel) or some other pre-existing condition,” said Gormsen. “If it’s truly as benign a fall as it seems and she already had an aneurysm, it could have started to leak and then ruptured an hour later.”

An aneurysm can be congenital or develop due to high blood pressure or other conditions, he added, and can be completely asymptomatic.

“If it leaks just a little bit, you might get a headache and some warning signs. You need a diagnosis and action to prevent the rupture because that usually is catastrophic,” Gormsen said, heartily concurring with Bartkowski on the importance of protective helmets for active sports.

What to watch for

Most childhood falls or blows to the head result only in juries to the scalp. More serious is an internal head injury. Here’s what to do if your child suffers a head injury, according to

Call the doctor:

- If your child is an infant

- Loses consciousness

- Won’t stop crying

- Isn’t walking normally

Apply an ice pack:

- If your child is not an infant

- Is awake, alert and behaving normally

- Also, observe him or her for 24 hours for signs of internal injuries

- During naptime, look for signs of twitching, color changes or breathing problems

- Trust your instincts and call the doctor if something doesn’t seem right

Reasons to call an ambulance:

- Unconsciousness

- Abnormal breathing

- Obvious serious wound or fracture

- Bleeding or clear fluid from the nose, ear, or mouth

- Disturbance of speech or vision

- Pupils of unequal size

- Weakness or paralysis

- Dizziness

- Neck pain or stiffness

- Seizure

- Vomiting more than two or three times

- Loss of bladder or bowel control

Prevention safeguards:

- Childproof your home to prevent accidents

- Wear protective headgear

- Use seat belts and child safety seats

- Always supervise children

Canton Repository