Every blow to head needs attention

The tragic death of actress Natasha Richardson in March riveted people's attention to the issue of brain injury and raised important questions about what to do if this happens to you or a loved one.

Richardson died hours after taking a minor fall while skiing at a Quebec resort. She picked herself up from the fall and refused medical attention, but three hours later in her hotel room, she complained of a headache. Within hours she was in critical condition. Two days after the fall, she died.

"Even when someone looks fine initially, it can still have devastating consequences," said Dr Greg O'Shanick, national medical director for the Brain Injury Association of America. "The critical issue is that you don't have to lose consciousness to sustain a significant brain injury," he explained.

Richardson's death saved life
"In this case, Richardson had what's called an epidural haematoma," O'Shanick continued. "There's an artery that runs right underneath the skull, and the skull on the temple is very thin. You can break the bone, the bone cuts the artery and a high-pressure blood clot forms. That then squeezes the brain."

Richardson's death, though, is known to have saved at least one life. An Ohio couple whose 7-year-old daughter had been struck in the temple two days earlier by a baseball hit by her dad rushed the girl to a doctor after watching a news report on Richardson, according to published reports.

It turned out she was suffering from the same condition as Richardson. Her parents' quick action was credited with saving the little girl's life.

Greater awareness
More than 1.4 million people suffer a traumatic brain injury each year in the United States, according to the Brain Injury Association of America. Most are treated and released from an emergency department, but 235 000 are hospitalised and 50 000 die.

Dr Rade Vukmir, an emergency department physician, clinical professor of emergency medicine at the University of Pittsburgh and a spokesman for the American College of Emergency Physicians, credits media coverage of Richardson's accident and death with making people more aware of potential brain injuries.

However, Vukmir said, it's still too early to tell if that awareness has translated into more people coming to emergency departments worried about head injuries.

O'Shanick said his organisation received many phone calls and website hits in the days after Richardson's injury. "They wanted to find out a lot about the basics of head injury, prevention issues, how much of a hit does it take to create that kind of injury," he said.

People seem to have a good understanding of the basics of head injuries, Vukmir said: "Most people who pass out know to come in. Most people who vomit know to come in."

But the real problem, illustrated by the cases of both Richardson and the Ohio girl, is that potentially fatal brain injuries don't always produce severe or noticeable symptoms.

Nonetheless, certain steps should be taken to ensure that someone who's taken a blow to the head will be all right. They include:

• Stay with the person. "If there's a question of what's going on, don't let the person be by themselves," O'Shanick said. "Make sure there's a person in attendance, watching over them. If you see someone once and they go off to their hotel room, unless there's someone there watching, no one's going to know about any changes in behaviour. You really do need to make sure there's someone watching."
• Watch for behaviour changes. If the person becomes suddenly drowsy, irritable or confused, acts in a drunken manner, begins repeating statements or has trouble walking or speaking, get the person to an emergency room immediately for treatment, O'Shanick said.
• Be particularly cautious with high-risk groups. The very young, the very old, people on blood thinners and anyone who's intoxicated are at increased risk for brain injury and should be given special attention if an injury is suspected, Vukmir said.

Of course, there's no reason at all to maintain a wait-and-see attitude, he added.

"We encourage patients to present themselves if they have any questions about their head injury," Vukmir said. "Call a health care professional or present yourself for emergency care so we can ask the questions and sift through the information." - (Dennis Thompson/HealthDay News, June 2009)

Read more:
A fatal blow
Richardson's diagnosis confirmed