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March 18th, 2009
09:53 PM ET

Why seemingly minor head injuries can be serious

[cnn-photo-caption image=http://i2.cdn.turner.com/cnn/2009/SHOWBIZ/Movies/03/18/obit.richardson/art.richardson.gi.jpg caption="Natasha Richardson fell on a beginners' slope in Canada."]

Brian J. Zink, M.D.
AC360° Contributor

The tragedy of Ms. Richardson's death illustrates that something far worse can take place after what might initially seem to be a minor injury to the head.

Simply put: any person with even a minor head injury who has a decreasing level of consciousness should be seen immediately by qualified medical providers.

That’s because one of the most devastating types of bleeding in the brain – epidural hematoma – can first seem like a mild concussion, but within minutes to hours can produce severe swelling in the brain and can lead to a comatose state.

Most head injury experts have seen patients with this condition who initially seemed otherwise fine.

Just as important, serious brain injury can occur without any visible external injury to the scalp or face. The injury happens because the brain is set into motion inside a rigid, unyielding skull. In my many years of practicing emergency medicine, I have often been struck by the lack of serious brain injury in injured people with maimed and bloody faces and scalps, and the presence of serious brain injury in people who have no apparent external signs of trauma to the face or head.

Advances in the treatment of severe traumatic brain injury over the past 40 years have reduced deaths, and improved neurological outcomes in those who survive, but the best treatment is through prevention.

Use of approved helmets in sports activities markedly reduces the chances of a significant brain injury should there be a blow to the head.

Since no one plans on having an accident or untoward event in what are usually fun activities, it is essential that we all get in the habit of wearing helmets (and most importantly ingraining this in our children) to prevent injury to our most vital organ.

Editor's Note: Brian J. Zink, MD Professor and Chair Department of Emergency Medicine Alpert Medical School of Brown University Physician-in-Chief Emergency Medicine Rhode Island and The Miriam Hospitals President University Emergency Medicine Foundation.

soundoff (16 Responses)
  1. NJ RN

    With sympathy and respect to the family of Natasha Richardson, I am wondering if organ donation was ever considered. An otherwise healthy 45 year old well known woman would have made an excellent donor and drawn some attention to this much neglected subject. Perhaps her family could have had some solace in knowing that her death gave life to others.

    March 19, 2009 at 11:53 am |
  2. Joanne Pacicca, Solvay, NY

    Thank you for the the explanation of a profoundly tragic happening. The helmet rule is essential!

    March 19, 2009 at 10:17 am |
  3. Alyzabeth

    So sorry to hear about this incredibly tragic accident. My best to Natasha's family and friends.

    March 19, 2009 at 10:07 am |
  4. brenda

    Just want to send my heart felt sympathy to the Richardson's family. I really admired Iam and Natasha as a couple. You could see the love they had for each other. My heart goes out to them.

    March 19, 2009 at 9:35 am |
  5. Michael "C" Lorton, Virginia

    Excellent advise that we should all be aware of and follow.

    March 19, 2009 at 8:26 am |
  6. Heather - Spokane, WA

    Its so amazing how strong the brain is but also how sensetive it is. You never think of any damage done to your brain if you just bump your head slightly on something but you worry if you hit it hard. I cant begin to tell of how many times I've hit my head hard and never thought of what damage it could cause. When I was six I was bucked off of a horse and hit a solid wood fence and never lost consciousness or even had any head pain, just scared the daylights out of me from what I was told, and never had any problems. Truly amazing. My thoughts and prayers are with her family.

    March 19, 2009 at 3:10 am |
  7. Don, WA

    To add to my earlier comment if I may – keep a sharp educated eye on your condition after a blow to the head – again you can't wear helmets through life, but what is learned here I think is that if you take a hit to the head, watch yourself, or your loved one, or anyone, for the symptoms – that's a much more important point in this case, I think, than wearing a helmet on the bunny slopes. Bless Ms. Richardson and family.

    March 19, 2009 at 2:37 am |
  8. Jill, Franklin, Wi.

    Maybe it should be required, when you take ski lessons, you have to have a helmet on. None of us wore helmets 20 years ago for anything. However, knowledge is a great thing. We know that helmets can save your or your CHILDRENS lives, so wear one! I am so saddened by Natasha Richardson's death. My heart and prayers go out to Liam and her sons, and the entire family.

    March 19, 2009 at 2:11 am |
  9. Don, WA

    One cannot wear helmets through life, or stay cooped up in closets watching life go by – Ms. Richardson lived...that's all we do at best...I am glad she learned how to ski in life.

    March 19, 2009 at 1:43 am |
  10. GiGi GOLD

    When I was 5 yrs old I fell from a swing in the garage and hit my head pretty hard against concrete floor, and once again in 2001 while I was skating very fast in an outdoor concrete floor skating park. I trip over small rock and my head hit the concrete so hard that my head bounced three times like a basketball. It felt like a bomb inside my head, followed by a terrible pain. Went home because I got very sleepy. No adult available to take me to Kaiser. I was advised to have someone to wake me up every hour throughout the nite. I'm confused and terribly sad for what happened to "beloved Natasha." She took small fall. Why I'm still ok? Go figure!! My heart goes to her love ones.

    March 19, 2009 at 12:58 am |
  11. Elaine

    It is truly amazing that the family of Natasha Richardson did not even wait for a few days to see if she could survive this brain injury. I believe the decision to pull the plug was made too hastily. Doctors or family cannot assume the role of God. Maybe if they had waited a few days a miracle could have taken place through much prayers and fasting. Many of you may scoff at this, but I have seen some miracles taken place, even when every hope was lost. Families need to wait and pray before making decisions like these. My prayers go out to the children who must be really hurting from all of this. I enjoyed watching her in the Parent Trap so much – she played her role so well!

    March 19, 2009 at 12:41 am |
  12. Neo

    Responsible reporting. Helmets and immediacy, understood. Mrs. Richardson did go to the hospital within an hour of her accident, according to CTV they stabilized her and sent her to the head trauma hospital. I guess in time we will know why she was airlifted.

    My heart goes out to the family, I can't even begin to understand this loss. I really liked Mrs. Richardson.

    March 19, 2009 at 12:23 am |
  13. John Collister

    Natasha's death is very tragect, but I certainly hope, that her death, caused by not wearing a helmet, so that she could be recognized,
    can be a lesson, to everyone, that wearing protection equipment, no matter who you are, is certainly worth it, especially when taking part in activities that can be concidered very prone to accidents.

    March 18, 2009 at 11:33 pm |
  14. Nancy Harrison

    This sad ending for Natasha Richardson is a teachable moment for all of us as to what "brain death" really is, how that determination is reached, and what it means for the patient and family. It might also be an opportunity to speak about organ donation. April is donor awareness month.

    March 18, 2009 at 11:26 pm |
  15. Kim

    I have learned my lesson and will wear a helmet from now on while skiing!

    March 18, 2009 at 10:21 pm |
  16. Rachel Doherty

    Isn't it posssible that if Ms. Richardson had been helicoptered to Montreal's Royal Victoria Hospital/Neurological Institute , instead of far away New York City, that she might have stood a better chance of surviving.

    March 18, 2009 at 10:17 pm |