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, 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 “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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