Actress Natasha Richardson's fatal brain injury was an epidural hematoma

Actress Natasha Richardson died after suffering a head bump that seemed no worse than those that my son had as a child when he would jump or crash into hard objects. After Richardson’s death, the question on a lot of minds is what distinguishes one kind of head trauma from another–and how you can tell before it’s too late. According to the TIME magazine Health report, head injuries are very common–with some 1.5 million in the U.S. last year. While many injuries to the head are superficial and short-lived, many others have long-term and even permanent consequences. The signs of a serious blow to the head include:

  • headache that gets worse,
  • confusion,
  • disorientation,
  • vomiting,
  • slurred speech,
  • sleepiness,
  • a droopy eye,
  • clumsiness, and
  • any kind of amnesia.

The signs of traumatic brain injury can be subtle. “They gradually progress,” says Dr. Carmelo Graffagnino, director of the neuroscience critical-care unit at Duke University. “Then suddenly it gets to the critical point that a person can’t be woken up.” Clients family members tell me that the signs and symptoms are not always obvious.

The outlook for a patient depends in part on acting fast: call 911 or drive the victim to the hospital; do not wait to reach your own doctor. The rest turns on the type of injury. Richardson died of an epidural hematoma, an accumulation of blood between the skull and dura, the tough tissue covering the brain. A subdural hematoma is blood between the dura and brain. Both injuries have a mortality rate of about 50%. Intracerebral bleeding, which occurs within the brain, is even more serious. “Patients get redlined to surgery in 15 to 30 minutes” if they have any of these injuries, says Dr. Neil Martin, chairman of the department of neurosurgery at UCLA.

Other head injuries include skull fractures, which can lead to brain bleeding, and concussions, which typically don’t–but which can lead to swelling and potentially permanent brain damage. As a general rule, doctors say that any head injury should be treated within the so-called golden hour after it occurs. In some cases, hospitalization and drugs may resolve the problem.

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