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Traumatic Brain Injury / Natasha Richardson

Newsweek ran a pretty clear description of the details of how Natasha Richardson’s minor skiing accident resulted in an unexpectedly dire brain injury. It includes details of symptoms and care. Here are excerpts from that article:

….

In rare cases, the trauma of hitting your head can have dire consequences, including bleeding and swelling of the brain. In some instances, these injuries aren’t immediately apparent because the patient may initially be lucid and without serious symptoms.

Actress Natasha Richardson’s recent skiing accident appears to be one of these unusual and tragic situations. The Tony Award-winning wife of actor Liam Neeson fell during a ski lesson on a beginner slope at a Canadian resort on March 16. At first, she showed no signs of major injury and was even joking about the incident, according to media accounts. But within hours, her health deteriorated and the 45-year-old mother of two was hospitalized and then subsequently transferred to a New York hospital.

What’s the difference between an ordinary bump on the head, and an injury that may not appear to be serious at first but is potentially critical? The most common thing that happens is that a fall shakes the brain and it then manifests as a concussion. But a concussion by definition is a brief or temporary disruption of the brain. Concussion never lands you in an intensive-care unit. A possibility [in accidents similar to what reportedly happened to Natasha Richardson] is that the fall triggered a syndrome of delayed massive brain swelling.

How can doctors make a diagnosis of a serious brain injury when the patient doesn’t have symptoms immediately? Through a different mechanism than concussions, trauma can rarely trigger a delayed and more sinister reaction or form of injury. These situations occur in two ways: huge swelling of the brain or bleeding on the surface of the brain—both would have an abnormal CAT scan. [After a fall] there is commonly a lucid interval where you may seem fine for an hour or two and then may develop symptoms of a more urgent nature unless something is done to reverse it … like surgery.


What advice would you give to someone who hits their head and may be unsure whether it’s a serious injury? 
What happens a lot of times is that someone is on a ladder and falls off, and they have a concussion. They may pass out, wake up and have a persistent headache and generally don’t feel good. Then, you call 911 and take them to the emergency room right away. We have a saying in neuro:  “Time equals brain.” For these kind of neurological emergencies, the earlier you can figure out what’s going on the better. Literally every minute counts. What happens to you in that first day will often dictate if you’re going to live, die, live with a full recovery or live with some kind of permanent brain injury.

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About ilanaturgy

Ilana Brownstein is a dramaturg and director specializing in new play development, based in Boston. She is the Founding Dramaturg at Playwrights' Commons and the Director of New Work at Company One.

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