Is Natasha Richardson brain dead? Was an epidural bleed, or “talk and die” syndrome, to blame after her ski accident?

Tragic news this morning regarding actress Natasha Richardson, who reportedly, suffered a head injury during a ski lesson in Canada.

According to reports, she fell on a beginner’s ski hill, and did not hit anyone or anything during the fall. There was no obvious sign of injury, and in fact, she was “was walking around and feeling fine for an hour after her accident.”

Things then took a marked turn for the worse, when she reported a headache an hour later, and was transported to a hospital, and subsequently admitted to the intensive care unit.

There are varying accounts of what happened next, with most saying she is brain dead, and is now in New York, where she can be with her family.

So, as many people I’m sure are wondering, how can an apparently minor fall lead to brain death 24 hours later?

I don’t have the answer, but here is no shortage of medical pundits who can provide a hypothesis.

The most popular one has been forwarded over at FOXNews.com, where an epidural bleed causing so-called “talk and die syndrome” is a leading possibility:

“I can only speculate, but it sounds like something we call the’talk and die’ syndrome,” said Dr. Steven Flanagan, director of Rusk Institute of Rehabilitation Medicine at New York University’s Langone Medical Center.

“What this implies is that someone hits their head and they are seemingly OK initially,” he told FOXNews.com. “But then they get a rapid collection of blood “” usually called epidural hemorrhage “” and that means bleeding between the skull and the brain.”

The physician blogging at Kennedy’s Tumor offers other possibilities in the differential, including, a subdural hemorrhage, or a subarachnoid hemorrhage, from say, an aneurysm.

He notes that an epidural bleed requires a significant, focused, blow to the skull, “such as that produced by a hammer or baseball bat. In 85-95% of patients, this type of trauma results in an overlying fracture of the skull.”

Can a seemingly minor fall cause such force? It’s possible, but apparently, there were few witnesses to the fall itself.

Assuming an epidural bleed, the treatment calls for quick action and immediate surgery:

If the condition is not treated immediately, the person will fall into a coma and “it’s downhill from there,” Flanagan said.

“So you need to get the injury treated immediately,” he said.

“First we would do an emergency CAT scan to find out exactly where the hemorrhage is, and then the patient would need immediate surgery.”

Already, there are some distasteful rumblings of whether Ms. Richardson would have had a better outcome had she gone to an American hospital. If she was in the United States, would access to a neurosurgeon have been quicker, and perhaps, life saving?

It’s far too early to speculate, but I won’t be surprised if this story takes an unsettling turn into a Canadian versus American hospital response debate.

It’s tragic that such a common incidence can turn so tragic, and my thoughts are with Ms. Richardson and her family.

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  • lukas Zinnagl

    isnt’t this typical for a epidural bleeding? like really really typical?

  • Dr. Mary Johnson

    Kevin, I think it is very inappropriate to be involved, in any way, in all of the speculation (and that’s what it is – people “showing off” their medical knowledge) surrounding Ms. Richarson’s condition.

    In point of fact, by chiming in, you’re just another pundit here.

    My thoughts and prayers are with Ms. Richardson, her husband, sons, Mother and family. And that is the ONLY message we as physicians should be sending to them right now.

    Their lives should not be reduced to public service announcements – or policy debates.

  • Kipper

    I don’t think the access to neurosurgeons is all that great in US ski resorts, either, just judging from the experiences of friends who’ve broken necks and backs in Tahoe. I can’t imagine why a neurosurgeon would be available in an area that only has the population density to support the practice on winter weekends.

  • Pam Sherwood

    I created a memorial for Natasha so people can leave their memories of her. Our hearts go out to Liam and their two sons.

    http://www.ilasting.com/natasharichardson.php

  • Mely

    I don’t think we can make speculations about access to neurosurgery in Canada when she declined ambulance transport and the ambulance had to turn around and leave.

    As a member of the Canadian Ski Patrol, if I’m telling you as a patroller to get in the ambulance, there’s a damned good reason I’m making that recommendation.

    The hospital she was transported to has a CT scanner and would have easily been able to transmit CT images to a neurosurgeon at Sacré Coeur electronically. Transfer would have been necessary anyway; the hillside hospital had no ICU. Hôpital du Sacré-Coeur du Montréal is a neuroscience and neurosurgery research center.

    Pundits are free to speculate about whether a neuro center in the USA is better than a neuro center in one of the largest metropolitan centers in Canada, but it’d be pure speculation.

  • coffee maker

    the loss of Natasha Richardson makes me re-think my resistance to wearing a helmet while skiing

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