Natasha Richardson and head injuries

Posted on March 18th, 2009 by ecthompson

Natasha Richardson, the 45-year-old actress, died today of a head injury. My heart goes out to her family and loved ones.

We see this over and over again in my line of work. It is the suddenness of trauma. Just yesterday or just this morning… or only an hour ago, our loved one was fine and then something happens.

As a trauma surgeon, I have no comment on her initial care, her flight from Canada to New York or her care at a New York hospital. Most of those details have been kept from the press. I will make a few general comments on head injuries. First of all, head injuries are extremely difficult to take care of. In spite of advances in CT scanners, operative therapy and ICU care the mortality rate from head injuries remains high.  Currently, our therapy focuses on reducing damage that has already been done. Our therapy focuses on limiting the area of damaged tissue. As of now, we have no way of reversing damage that’s already been done.

Secondly, prognosis is extremely difficult in many of our cases. Invariably, a family looks at me or any of the other physicians taking care of the patient wanting to know how was their loved one is going to be?  Initially, with just a few exceptions, we have little or no idea. All we have is generalizations. In general, older people do worse than younger people. Patients on blood thinners will do significantly worse than those patients who were not on those medications. Now don’t get the impression that we don’t know anything. There are tons of studies which have enrolled thousands of patients, so we do know a lot. We are not, though, being asked about a large cohort of patients. Rather, we’re being asked about one specific patient. Translating studies to a specific patient can be difficult if not impossible.

Thirdly, head injuries are a leading cause of death in the United States.

Finally, the suddenness of trauma makes it difficult for everyone involved. When psychologists talk about life stressors, this is stress to the max. Again, my heart goes out to the family.

Tags: Entertainment, Healthcare // View Comments

  • Carol Johnson
    Virginia - I had never seen that picture before. Thanks for that. It is great as well as the text that went with it.
  • Virginia Cotts -

    you are 100% correct. It would be nice if helmets for motorcycle riders and bicycle riders become more the norm and not the exception. It is clear that they save lives and reduce injury. (I wrote a piece on motorcycle safety.)

    Here's that picture that you referenced -
    <img alt="Obama in Bike helmet" src="http://www.whereistheoutrage.net/wordpress/wp-content/uploads/2009/03/13obama-bike.jpg">
    Great picture for safety.

    thanks for your thoughtful comments.
  • AnacherForester -

    I'm not sure that you can categorize dramatic brain injured patients as infinitely or was it exponentially less likely to seek medical care. It is clear that some of them are not thinking clearly and therefore don't seek medical care.

    I'm glad you're better.

    Thanks for your comments
  • Ed-words -

    I have no idea. I've never been skiing. it is clear that helmets help but they're not perfect.

    Thanks for your comments.
  • Sid Schwab -

    thanks for your thoughts. I appreciate them.
  • offog
    My condolences to Ms. Richardson's family and friends. She was more than a beautiful and talented actress. Her family is a good bunch of people.

    Re: Helmets. Maybe it will be good to raise some awareness.

    Head injuries are nothing to mess around with. When I was a little kid, my Mom's friend had a small boy who fell down the stairs. He was a little dazed for a few minutes, but seemed to be okay. Then he died from the injury. Because of that, Mom knew enough to take us kids to the ER if we hit our heads, like the time my little brother fell off a shelf. The hospital kept him overnight for observation, just in case.

    When I was walking to the office one winter day a few years ago, I fell flat on my back and hit the back of my head really good. The next evening, I came down with severe nausea and headache. So over to the ER I went. I got my head examined, and fortunately, got a clean bill of health.
  • Virginia Cotts RN BSN
    I'm glad to find an expert in the field writing about this. As an RN for 32 years, much of it in critical care, I have a lot of experience with families who want projections on the recovery of their loved one after they have first seen them in the ICU. IF the patient recovers, it can be anything from routine to inexplicably amazing.

    What I hope to see is a push by the neuro and rehab communities about wearing helmets. I've been appalled at how many blog comments have insisted that 'no one wears a helmet when skiing'. The competitors do, but apparently they don't count.

    My 29 and 24 year old kids grew up being the only ones on the block who had to wear bike helmets. They wear them still, for motorcycles, snowboarding and anything else that means their bodies are moving faster than walking speed.

    Which should explain one of my favorite pics from the campaign - and Obama's very conscious decision to set the example.

    http://thecaucus.blogs.nytimes.com/2008/06/13/obamas-helmet-moment/
  • AnacherForester
    Unlike broken limbs, puncture wounds, etc., brain injuries are frequently difficult to recognize at first. For all intents & purposes this kind injury is invisible. Avoiding a trip to the ER is human nature. Compared to other trauma injuries a person w/ a TBI is almost exponentially less likely to seek medical attention. TBI's can seriously impair judgment too.

    I have firsthand experience with a TBIs. I too initially refused medical treatment. It's no exaggeration to say I'm lucky to alive (tho' I do have a seizure disorder & other health problems as a result). This easily could have been my story.

    What a shame. My thoughts are with her family.

    -AF
  • Ed-words
    It wasn't like she tripped coming out of a store

    She was learning to ski! Don't (at least)

    beginning skiers wear safety helmets?
  • Yes, I do know that; and now, of course, the autopsy has confirmed. I was responding to the initial information that it was a "routine" fall on a learners' slope.
  • Sid Schwab -

    There is a misperception in the public that everyone with a head injury just keels over and collapses, that's not the case. I admitted a guy just couple weeks ago who was hit in the head repeatedly with a bat and he came to the hospital at little sleepy He had a subarachnoid hemorrhage.in that same vein that took care of a lady who was in her mid-80s she had fallen over a month ago she a large subdural hemorrhage on both sides of her brain but did not present until four weeks after the incident.

    Thanks for your comments.
  • H. G. Lite -

    This was most likely what it seems. A head injury. Sorry about your friend.

    Thanks for your input.
  • patrick -

    You are right. This type of event does occur every day. If we think back something similar happened to one of the Kennedy's and to Sonny Bono. Yet, no new research or funding.

    Thanks for your thoughts.
  • aimai - Sorry for your loss. Thanks for your comments.
  • GIven the information that she was initially fine, don't you think it likely that there was underlying pathology, such as a cerebral aneurysm? And that the bleed might even have been unrelated, or secondarily related, to the fall?
  • H. G. Lite
    The possibilities are endless and sometimes don't make any sense unfortunately until an autopsy is performed, as in the case of a friend’s daughter who suddenly collapsed, and postmortem was diagnosed with a dissecting aneurysm of the cerebral artery. My thoughts and condolences to the family for this tragic loss.
  • patrick
    This type of accident happens probably every day... one can only hope that because of her celebrity status, more people will have become aware of how serious any head injury might be.
  • aimai
    My heart goes out to her family. She was a wonderful actress and a glowing presence on the screen and, apparently, off. I am personally extremely upset by what happened to her because, as far as I can see, a quicker realization that she was suffering from bleeding on the brain would have enabled them to operate to relieve pressure before her brain was gone. I have a personal experience of this and I know how surprising and shocking this is. My niece, also named Natasha, died of a related but spontaneous brain embolism within days of her first days in third grade. By the time the family figured out something was wrong the bleeding was so far advanced that she weas brain dead. But there was no precipitating fall or knock that might have offered a clue as to what was going on.

    My heart is broken for Ms. Richardson's children and husband. This is a terrible loss.

    aimai
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