By Simeon Margolis, M.D., Ph.D.
The dangers of head injuries were highlighted by the shocking death of well-known, 45-year-old actress Natasha Richardson on March 18, 2 days after what appeared to be a minor fall on a beginners' ski slope in Canada.
Immediately after the fall, Ms. Richardson was conscious and even joked about falling. Apparently, an ambulance was dispatched to the ski resort shortly after the fall—an unusual step following only a minor ski accident—but she declined to see a doctor as advised by both her ski instructor and a member of the ski patrol.
About an hour later, however, Ms. Richardson began to complain of a crushing headache; another ambulance was summoned and she was taken to a small nearby hospital. Ms. Richardson died despite being transferred quickly to a major medical center in Montreal and then, about 24 hours after she fell, to Lenox Hill Hospital in New York City.
An autopsy showed that the cause of death was an epidural hematoma, a collection of blood in the epidural space between the skull and the dura matter (the outer membrane that lines the brain). Most often in adults, such bleeding results from a tear in the middle meningeal artery, a major artery that supplies blood to the brain. Less frequently, bleeding may result from damage to a vein that drains blood from the brain.
Although the initial small amount of blood in the epidural space may cause no symptoms, continued bleeding enlarges the hematoma, which puts pressure on the brain and can cause serious consequences, as it surely did in this case.
Doctors will suspect an epidural hematoma by a few typical manifestations. Often, there is a lag between the injury and the symptoms, and the injury can be verified by a computed tomography (CT) scan of the head. The condition can usually be treated successfully just by removing the accumulated blood from the epidural space. Sometimes more extensive surgery is needed to repair a lacerated artery to stop further bleeding.
It is unclear whether a helmet would have lessened Ms. Richardson's head trauma or if more immediate and intensive treatment of the hematoma would have prevented the tragic outcome.
Obviously, we can't call our doctor or go to an emergency room every time we bump our head on a low ceiling. Nonetheless, this incident serves as a warning that we all must take blows to the head seriously, even the "milder" ones. And, of course, severe blows to the head or loss of consciousness after any head trauma is sufficient reason to seek immediate medical attention.
Even if you haven't lost consciousness and feel pretty good immediately after a seemingly minor blow to the head, you should be taken to an emergency room immediately if you develop a headache that is getting worse. Other warning signs of brain damage can be vomiting, increasing confusion, or other behavioral changes.
Though a helmet might not have prevented Ms. Richardson's particular injury, wearing one always makes good sense whenever you are skiing, riding a motorcycle or horse, riding a bicycle in traffic, or (for children especially) first learning to ride a bike.