Don’t dismiss head injuries

BALTIMORE — The death of 45-year-old Natasha Richardson last week from what had been labeled a “mild brain injury” after a skiing accident has experts in trauma warning the public to take a blow to the head seriously.

An autopsy confirmed the actress, who fell on the slopes, died of an epidural hematoma, which is bleeding between the skull and the outer layer that covers the brain called the dura. But doctors not involved in her care noted reports that said she initially refused treatment.

It’s not possible for those who didn’t examine her to say faster treatment would have saved her. And death from such a seemingly minor accident is rare. But they agreed any blow to the head that causes an ache that gets worse requires immediate medical attention.

“There is no such thing as a mild head injury. It’s a misnomer,” said Vani Rao, director of the Brain Injury Program at Johns Hopkins Bayview Medical Center and a neuropsychiatrist. “Go to the emergency room immediately and get a complete evaluation.”

Rao estimates that up to 75 percent of head injuries are labeled mild, but in up to a quarter of those cases, there are significant problems, including sleep and memory troubles, loss of cognitive abilities and changes in motivation and attitude. Many people or their families notice changes in behavior hours, days or even weeks after a person has hit his head, she said.

In many cases, bleeding is usually revealed by a timely CT scan, which is a more sophisticated X-ray of the body that shows cross-section images, said Dr. Howard Eisenberg, chairman of neurosurgery at the University of Maryland School of Medicine.

An epidural hematoma, which is what an autopsy determined killed Richardson, is usually treatable. Doctors drain the blood that is pooling and clotting and causing pressure on the brain. Small ones can heal without surgery.

Because Richardson was conscious and talking immediately after the accident, she may not have believed the problem was serious. It was reported that she developed a headache about an hour after the accident. Eisenberg said that just meant the initial bleeding was slow.

He said a headache that gets worse is the key symptom of a problem. Others who likely need medical attention after a blow to the head are also increasingly dazed, vomiting or having other behavior changes. They don’t need to have lost consciousness.

“We all hit our heads and don’t go to the hospital,” he said. “But if you’re skiing and you hit a tree, if you fall off your roof or get in an auto accident and hit your head, obviously you need medical attention. If you stand up and hit your head on a shelf, probably not. Consider the force.”

He also said consider a little prevention. Eisenberg said he decided to start wearing a helmet to ski when he was having lunch with friends before they hit the slopes. They all had their helmets at the table.

“I got up, told them to order me a burger, and I went and bought a helmet,” he said. “I’m the neurosurgeon. I should have known.”

Helmets probably wouldn’t have saved performer and U.S. Rep. Sonny Bono and Michael Kennedy, son of the late Sen. Robert F. Kennedy, who both died after skiing into trees, according to Bill Howard, director of the Arnold Palmer Sports Health Center at Baltimore’s Union Memorial Hospital. Helmets do spread some trauma from a blow, but not that much.

And he said a helmet wouldn’t have helped Richardson if, for example, her vein tore from being stretched as she fell or her brain hit her skull suddenly when she hit the ground. Still, he wouldn’t discourage skiers from wearing one, as long as they don’t believe it makes them invincible. And they should seek medical attention when they need it.

“The problem is, everybody bumps their head, and we don’t all need ey should seek medical attention when they need it.

“The pr long as they don’t believe it makes them invincible. And they should seek medical attention when they need it.

“The problem is, everybody bumps their head, and we don’t all need to go to the emergency room for CT scans,” he said. “That being said, everyone should be aware if you get struck on the head and it’s a moderate blow, (and) there’s pain that gets worse, even a little bit, that’s a clue to stop what you’re doing and get to the hospital.”

Tags: health, head injuries, natasha richardson, features