Brain Injury Patients May Seem OK , Then Get Sicker
Trauma surgeons and neurosurgeons weighing in on the Natasha Richardson tragedy have stated that she might have survived if she had had surgery shortly after the injury occurred.
At first, Natasha Richardson said she felt fine after she fell on a Canadian ski trip. But that’s not unusual for people who suffer traumatic head injuries like the one that killed the actress.
Surgeons say sometimes patients with serious head injuries have what is called a “lucid interval” where appear normal for an hour or more as the brain slowly, silently swells or bleeds. Later, back at her hotel, Richardson fell ill, complained of a headache, and was taken to a hospital. She died Wednesday in New York.
An autopsy Thursday revealed that the 45 year old actress injured her head, which led to bleeding between the skull and the brain’s covering, resulting in what is known as an epidural hematoma. This injury is usually caused by a skull fracture.
Because of the “lucid interval”, doctors always tell patients who seem to be OK after a head injury to have someone keep a close watch on them, in case symptoms develop.
The important symptoms are: headache; a loss of consciousness; vomiting; problems with vision, speaking or moving; confusion; drainage of a clear fluid from the nose or mouth. These symptoms appear after enough pressure builds in the skull. By then it’s an emergency.
“Once you have more swelling, it causes more trauma which causes more swelling,” said Dr. Edward Aulisi, neurosurgery chief at Washington Hospital Center in the nation’s capital. “It’s a vicious cycle because everything’s inside a closed space.”
Pressure from bleeding or swelling can force the brain downward to press on the brain stem that controls breathing and other vital functions, causing coma or death. Emergency treatment involves opening a portion of the skull to give the brain room to swell without pressing on the brainstem. They also drain the blood and remove clots that are present from the bleeding.
“This is a very treatable condition if you’re aware of what the problem is and the patient is quickly transferred to a hospital,” said Dr. Keith Siller of New York University Langone Medical Center. “But there is very little time to correct this.”
Details of Richardson’s case have not been made public.
A CT scan can identify bleeding, bruising or the beginning of swelling after an injury. Patients may not know when to seek emergency treatment if the injury seems mild.
“If there’s any question in your mind whatsoever, you get a head CT,” Aulisi advised. “It’s the best 20 seconds you ever spent in your life.”
