Irony of Life: March is Brain Injury Awareness Month

The recent death of actress Natasha Richardson sheds light on how what we feel symptomatically has absolutely nothing to do with our true state of health. What appeared to be a minor fall unfortunately cost Ms. Richardson her life.

So many questions emerge as to how events may have unfolded differently. One thing is clear: Don’t waste time with asking a person if they want medical treatment and actually listening to what they tell you. How should they know? They may not be in their right state of mind and this could cost them a permanent disability and even their life.

It is obvious that immediate medical attention like a brain CT Scan would have been indicated and likely averted death or severe brain injury to Ms. Richardson. Even so, according to news reports, there was no medical helicopter available to escort Ms. Richardson to a facility who would even be able to handle a traumatic brain injury case. She needed to actually fly back to New York to be taken care of. Four hours passed and we know what the consequences were now.

The first ambulance that was sent to the ski resort in Mont Tremblant, 80 miles northwest of Montreal where there was a hospital who could handle brain injury, was sent away. I wonder how that could be – what folly that mistake was. Then an ambulance was sent to her hotel after she had symptoms and complained of a headache. Then she was rushed to the hospital. I am actually surprised the ski resort did not have more clues as to how to handle injuries of this sort given that their business is skiing and people can get seriously hurt. It is not as if Canada is a 3rd world country…

Then she was moved to a Montreal hospital. All these hospitals were apparently unable to respond appropriately to Ms. Richardson’s grave condition. Hours are passing at this time. Critical time for the brain to go into massive deterioration without oxygen and surgery to correct the bleed.

This is from the Huffington Post March 21 by Bonnie Fuller:
How can it be possible for a healthy 45 year-old woman to take a spill on a "bunny hill" and end up brain dead within the day?

That's the question that I posed to neurologist Dr. Dexter Sun, who practices at New York Presbyterian Hospital/Cornell in New York City. First of all, rest assured he said: this is a highly unusual case. Normally, a tragedy like this occurs only after a very heavy impact accident, says Dr. Sun.

With that said, Dr. Sun explained that there are three particular possibilities that could account for Natasha Richardson's state:

1. "She may have a fairly rare underlying hematology condition called hypocoagulation, in which she lacks a blood clotting factor," says Dr.Sun. This could be a genetic factor which had gone unnoticed throughout her life until now. When the clotting factor is missing, a minor bleed can become a hemorrhage.

2. It's possible that Natasha could have been taking a blood thinner like coumadine, for another medical condition, that would have made it much more likely for her to bleed after any head injury, according to Dr. Sun.

3. Finally, and most likely, she did have a harder spill than what has been reported. Sometimes when this happens "you can have a high level cervical spine fracture or a fracture at the base of the skull," says Dr.Sun. When this occurs, and the injured person continues to move around as Natasha did -- not realizing that she was seriously hurt -- the spine can touch the brain stem and cause a severe brain injury.

A high impact fall on the head can also cause three different types of bleeding within the brain: 1) an intracranial hemorrhage, which begins as a microscopic rupture of a blood vessel deep within the brain, 2) a subdural hematoma, which is a bleed that occurs in the dura, which is the outer layer of the brain, or 3) an epidural hematoma, which is a hemorrhage, that takes place between the outer skull and the dura.*

As for why Natasha initially seemed perfectly fine after her spill, apparently the hemorrhage can begin in one small spot in the brain and then grow in intensity.

All of these types of bleeding and the cervical spine fracture, result in dramatic swelling of the brain and pressure in the skull, which also pushes down dangerously on the brain stem, which is the center of life, according to Dr. Sun.

Big question: Was there ever a chance to save Natasha Richardson's life? If she hadn't insisted that she was fine and walked back to her room, could prompt medical treatment have made a difference?

Since initially there was no indication that Natasha's life was in danger, it's unlikely that she could have been saved. She would have needed to be rushed into the hospital and into a CT scan in a matter of minutes, according to Dr. Sun.

"If she had gone to the hospital and a CT scan indicated that there was bleeding, her skull would have been opened to relieve pressure, and she would have been given medication to relieve the pressure in her brain," he says.

Only then, would there have been a chance that she could pull through.

Tragic.

*The autopsy confirms that Richardson died from an epidural hematoma.

Would the helmet of saved her life? These are questions we really don’t have answers to. Most people do not wear helmets at all especially on the bunny slopes. Possibly now people will when they engage in activities that could possibly cause brain injury. It is just not something we naturally think about when going on an outdoor outing that is supposed to be fun, refreshing and seemingly safe for the brain.

More information can be found at: www.brainline.org and www.brainrecovery.com