We hope and wish for Natasha Richardson’s rapid and full recovery.
As a physician, I have unfortunately seen patients whose head injuries appeared minor at first, but have become rapidly life-threatening.
How can someone be “fine” after a head injury and then worsen, one might ask?
The most common cause of such a course would be bleeding in the brain from a subdural, or, more emergently, an epidural hematoma. An epidural hematoma usually occurs when there is sharp trauma to the head often accompanied by a skull fracture. Arteries, and, less frequently, veins can leak blood into the potential space in between the skull and the dural membrane that covers the brain. Unchecked, this leakage can accumulate and compress the brain, causing direct damage, shifting of the brain structures, and brain swelling. Epidural hematomas are life-threatening medical emergencies—arteries can leak significant amounts of blood in a short period of time. Many patients with epidurals seem to be “okay”, and then deteriorate rapidly to unconsciousness within 24 hours. They occur in 1-2% of head injury cases and are the main reason doctors recommend close observation of head injury patients for the first day after the trauma. Treatment includes stabilization of vital signs and life support, medication to decrease brain swelling and neurosurgical intervention to drain the blood and stop further leakage.
Subdural hematomas usually present with a slower onset, with venous leakage under the dural membrane causing compression of the brain and headache. Symptoms are usually milder and may take days to appear. These bleeds are more common in the elderly, and can occur in over 30% of head injuries in high risk populations. Treatment usually includes neurosurgery to drain the blood and close off any leaks.
Finally, aneurysms can develop after head trauma in some of the blood vessels in the area of injury. These can leak rapidly or slowly and lead to loss of consciousness, and/or symptoms of stroke. Neurosurgical intervention can once again clip the aneurysm and stop the blood leakage.
Rapid identification of one of these conditions and specialized medical care and treatment can go a long way towards promoting recovery and a good outcome.
I do not know the type and extent of Natasha Richardson's injuries, but I hope and wish for her rapid and complete recovery.
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