The tragic accidental death of respected actress Natasha Richardson has brought attention to how a bumped head might seem minor enough, but can turn out to be a life threatening brain injury.
Just as Natasha reportedly did, it's common for someone who's had a fall or been in a car crash to seem perfectly lucid just after the impact, only to deteriorate rapidly later on.
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"A patient can appear so deceivingly normal at first," said Dr. Carmelo Graffagnino, director of Duke University Medical Center's Neurosciences Critical Care Unit. "But they actually have a brain bleed and as the pressure builds up, they'll experience classic symptoms of a traumatic brain injury."
You may have heard this called "talk and die" syndrome.
The fall doesn't have to be all that bad. Natasha fell on a beginner ski slope and didn't seem to hit her head on anything. You don't have to see external injury to have injury to your brain. She was able to talk and joke with her ski instructor after the fall, and rejected medical care.
The onset of symptoms can be anywhere from five minutes to three hours after the accident - for Natasha it was two and half hours before she complained of the headache that brought an ambulance to her hotel.
Many times a patient is unaware they have fractured their skull, often just above the ear, in the temporal bone. The pressure pushes on the brain, causing swelling, but there's no room for movement in the skull cavity.
As the pressure continues, the blood flow to the brain is reduced and the patient starts to feel the symptoms.
Other times a subdural bleed, developing between the brain and the dura, can squash the brain. This type of injury takes longer to show symptoms - a patient might feel normal for several days before the trouble starts.
Some medications can increase your risk for hemorrhages, especially for older people.
If you're taking blood thinners or other prescription drugs these medications can make even a small bump on the head something to investigate, just to be sure.
In the hours after an injury to the head pupil size is monitored as well as asking basic questions such as the patient's name and what year it is. Keep an eye on the thinking skills, and react immediately by bringing someone to a hospital if you see something change.
The symptoms you'd watch for if you weren't evaluated at a hospital are nausea, severe headache, glossy eyes and sudden sleepiness.
If you get to a hospital for immediate treatment, you can usually survive the danger
Often an emergency craniotomy (actually opening up the skull) is needed to stem the bleeding and take care of swelling. The next step is to monitor the brain activity and check for permanent damage - patients usually spend about a month in a neuro-ICU, the next several years in physical and cognitive therapy to regain brain function.
"The most important thing to do to lower your risk is to wear a helmet when you can, and don't brush off an injury because you feel 'fine' at first," Graffagnino warns.
"The thing that's going to save a life is for friends and relatives to recognize the first glimmer of a symptom. The quicker we can stop the bleed, the better."
In fact, if any good comes out of the loss of a lovely, talented woman - wife, mother, daughter, sister - before her time, it is her story serving to save the life of another person.
Hit by accident in the head by a baseball, 7-year-old Morgan McCracken of Mentor, Ohio at first seemed fine. After hearing Natasha's story and recognizing the risk, her parents got Morgan life saving medical attention before it was too late.
The girl ended up having the exact same injury as Natasha, after a bumped head she was found to have an epidural hematoma, but she got her treatment in time. After surgery and 5 day a hospital stay, as children so often do, Morgan is back home and doing just great.
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Dec 07, 2011 16:11:35
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