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Brain Hemorrhage May Explain Natasha Richardson's Condition
Date:3/18/2009

Symptoms can take time to progress and cause real damage, doctors say

WEDNESDAY, March 18 (HealthDay News) -- Reports that actress Natasha Richardson may have suffered critical brain damage after a seemingly minor fall on a Canadian ski slope on Tuesday have many people wondering how this could happen.

But experts say these types of incidents can lead to injuries from as relatively benign as a concussion, to potentially lethal brain hemorrhages.

"If you take the name Natasha Richardson out of the picture and ask how a neurosurgeon would think of a case where someone has a fall which seems fairly minor and then deteriorates a few hours later, quite a few things would go through the surgeon's differential thinking," explained Dr. Arno Fried, chairman of neurosurgery at Hackensack University Medical Center in New Jersey. "It's not an uncommon scenario."

A worse-case scenario would be bleeding either on the surface or deep inside the brain, Fried said.

And this does fit with many of the details of Richardson's accident that are known at this time. According to news reports, the 45-year-old award-winning actress fell during a beginner skiing lesson Tuesday afternoon at the Mont Tremblant ski resort north of Montreal. She was not wearing a helmet.

Richardson suffered no immediately apparent injuries and was able to walk and talk right after the accident. "She was awake and alive and laughing and breathing," Catherine Lacasse, the public relations supervisor for Mont Tremblant Resorts, told Bloomberg News. "She refused to see a doctor. She said she was fine and everything was OK."

However, Richardson reported a headache about an hour after the mishap and her condition deteriorated. She was taken by ambulance to a nearby hospital, then transferred to Hopital du Sacre-Coeur de Montreal and then flown Tuesday afternoon to New York City, where she is reportedly receiving care at Lenox Hill Hospital.

News reports all suggest that Richardson's condition is extremely grave, with various sources saying she is in a coma, or on life support, or brain-dead.

"We don't know for sure what transpired but it does sound as though she could have had an expanding hemorrhage between her brain and her skull that simply got to a point that started to press on her brain significantly, causing considerable neurological compromise," said Dr. Steven R. Flanagan, director of the Rusk Institute of Rehabilitation Medicine at New York University's Langone Medical Center in New York City. He is not involved in Richardson's care.

Flanagan said a diagnosis of hemorrhage would account for the headache that surfaced after the accident.

And, Fried said, "slow bleeding [could] take a few hours to make itself known."

Hemorrhaging either on the surface of the brain or deep inside the brain could be deadly, experts said.

"The brain is contained within the skull and the skull is a rigid box. There is no movement [possible]," Fried explained. "Any pressure that builds up will put pressure on the brain, which is very unforgiving and sensitive to pressure."

On the other hand, the injury could be as minor as a concussion or contusion (bruising), or even an epileptic seizure that can often follow a mild head trauma, Fried said.

"It's not terribly common but someone can be perfectly lucid [after hitting their head] then go rapidly downhill," Flanagan said. "It's not a major surprise. It's clearly reported in the literature."

Dr. Eugene Flamm, chairman of neurosurgery at Montefiore Medical Center and Albert Einstein College of Medicine in New York City, agreed. He stressed that the low-velocity, low-impact type of accident that Richardson seems to have experienced would typically not result in a grave outcome.

Such outcomes are "pretty rare," Flamm said. However, he added that it was certainly a possibility that physicians hold in their mind when seeing patients.

"It's quite unusual, but we see a lot of people in the emergency room and if they have a head injury and the scan is OK, we send them home but with instructions to 'look out,' " Flamm said. "I don't think any neurologist would say they had never heard of this scenario."

Richardson, who has appeared in several movies and won a 1998 Tony Award for her performance in Cabaret, is married to the actor Liam Neeson. The couple's two sons were reportedly with Richardson on the ski holiday.

Neeson reportedly flew from filming a movie in Toronto to be with his wife of 15 years.

The actress Vanessa Redgrave, Richardson's mother, was seen entering Lenox Hill Hospital Tuesday night "looking somber," The New York Times reported. Her sister, actress Joely Richardson, was also spotted entering the hospital, CNN reported.

But there are so many missing details of what happened on the slope in Canada that really anything could still be possible, the medical experts said.

More information

Learn more about traumatic brain injury at the U.S. National Institute of Neurological Disorders and Stroke.



SOURCES: Arno Fried, M.D., chairman of neurosurgery, Hackensack University Medical Center, New Jersey; Steven R. Flanagan, M.D., director, Rusk Institute of Rehabilitation Medicine, New York University Medical Center, New York City; Eugene Flamm, M.D., chair of neurosurgery, Montefiore Medical Center and Albert Einstein College of Medicine, New York City; Bloomberg News; CNN; The New York Times


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