The reason I wanted to get into Natasha's case some more, is because I found a dangerous mis-conception in the comment of a ski-patroller in another diary about Natasha's accident. This is what he states:
I'm a Ski Patroller, and we take head injuries, no matter how apparently minor, quite seriously. Any time someone hits their head and can't immediately answer (and subsequently re-answer a few minutes later to check for degradation of their condition) some basic questions as to name, location(name of resort), day of week, and time of day (all must be answered correctly every time they're asked), we put them on a backboard and have them taken to a hospital for further evaluation - resort and patrol policy.
This is a reminder of how important these kinds of injuries are.
Any time you see someone take a fall (at home, in a bar, wherever) and they hit their head, ask them to repeat the answers to those questions...if they can't answer all four correctly, call an ambulance. Period.
WRONG,.......please follow me below the fold.
Despite this ski-patroller's best intentions, he still would have missed the severity of Natasha's injuries because with these kind of injuries, as was the case with Natasha, the person is totally oriented in time and space.
From what I can tell from the reports, the only symptom, and it was a delayed symptom, was that of a headache.
The worst part of such an injury, where the person is totally oriented in time and space, is the fact that an ER may also not take it serious, which is what happened to my son, and I want to make sure it NEVER happens to anyone else.
Let's hear what Keith Black says about what might have happened to Natasha, to understand how this talk and die syndrome can develop:
The tragic story, if confirmed, is a reminder that even minor blows to the head can lead to devastating bleeding that can cause strokes or otherwise damage brain tissue. One possibility, sometimes called "talk and die" syndrome, is that the actress had delayed bleeding between her skull and her brain stem, which sits at the top of the spinal cord and regulates consciousness, breathing, and the heart and connects the brain to many of the body's sensory and motor nerves. Another possibility is that there was a tear in the inner lining of her arteries, causing blood clots. To find out more about Richardson's potential injury, we spoke with neurosurgeon Keith Black, chairman of the Department of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles.
[An edited transcript of the interview follows.]
Based on Richardson's symptoms, what kind of injury do you think she suffered?
The possibilities range from what we call an arterial dissection to a preexisting condition that might have been triggered by the event. An arterial dissection is where patients have a very mild injury tear the inner lining of the arteries of the neck, either the carotid or vertebral arteries, and that can occur with even minor trauma that one may not believe to be significant. That tearing in the artery can cause clotting, which can set up a stroke (an interruption of the brain's blood supply caused by a blockage or a rupture of a blood vessel). If that clot is in the vertebral artery system, it can cause a stroke in the brain stem, which can be devastating.
The other possibility is delayed bleeding in the brain. That can be from either a tear in a vein or an artery in the brain tissue itself, and that can be either an epidural hematoma (between the skull and the dura, the membrane that surrounds the brain) or a subdural hematoma (between the dura and the brain).
Another possibility is that she had a condition that predisposed her to having a more catastrophic event. This could be an abnormality in how fast her blood clots after a bleed. Or if she's been on any aspirin, blood thinners, or, supplements like omega-3 fish oil, that can make things worse. The other thing one has to worry about is whether she had a vascular abnormality in the brain like an arteriovenous malformation (an abnormal connection between high-pressure arteries and low-pressure veins). If an AVM tears one can get a more significant bleed.
I think the two most likely conditions would either be the arterial dissection in the neck or the delayed bleeding within the brain itself.
Here is what happened to my son as I commented in the other diary:
"she was totally oriented in time and space.."
So was my son,.......he too had a vascular issue after a sports injury. Not a bleed, but a clot.
Problem is that they don't take you serious in the ER when you are "totally oriented in time and space.", even if you are developing a headache.
Precious time is wasted.
My son slipped into coma and when he woke up three days later, he was completely paralyzed,......only the blinking of the eyes was left.
And there was another very famous case with similar delayed symptoms. Remember the girl who walked away from the hockey stadium after being hit by a hockey puck? Well, she died suddenly three days later, and Sports Illustrated wrote about that case. I even talked with Sanjay Gupta about her case at the time, because as I said in the intro, I NEVER want this to happen to anyone else. And the only way to make sure nobody else goes through this kind of devastation is to educate those who need to know, like the professional care-providers, ski-patrollers and ER personnel.
See what happened to Brittanie Cecil, who was hit by a puck after a Columbus Blue Jackets player took a slap shot in the second period of a game:
''She died as a result of damage to the right vertebral artery,'' Bradley Lewis, the Franklin County coroner, said yesterday. ''When she was hit with the puck, her head snapped back in a type of whiplash action and caused damage to her artery.
''The problem was she did not have any symptoms, until relative to the terminal event when she lost consciousness.''
Brittanie was taken to Children's Hospital in Columbus after being treated at a first-aid station at the arena. She spent a day and a half in bed, often awake and talking, and did not show any symptom of a rupture to the vertebral artery -- lethargy, slurred speech, partial facial paralysis -- until she lapsed into unconsciousness at 9 a.m. Monday, Lewis said.
The hospital did an angiogram and discovered the injury to the artery, which runs along the spine and pumps blood into the brain, Lewis said. Doctors tried treating Brittanie, but the rupture had caused a clot to form in the artery, leading to more clots and a swelling of the brain that ultimately resulted in her death, Lewis said.
''It appears they did everything appropriately and everything that could be done,'' Lewis said.
I also completely disagree with the ER doc quoted in that article:
Dave Milzman, a professor of emergency medicine at the Georgetown University School of Medicine, said in an interview that it was ''a totally freak injury.''
''The way this unfortunate girl died, this is not something they could have thought of,''
That kind of thinking, and the thinking of the ski patroller that I started my diry with, will continue to make that Precious time is wasted, when any delay can be fatal.
Luckily my son survived, but he has now been paralyzed from the nose down for the past 12 years, which could have been prevented had the ER acted swiftly.
In closing, I want to say that what happened to Natasha isn't a "freak accident" as many like to claim. Unfortunately sports injuries and other "minor" blows to the head can easily cause this kind of rapid deterioration from delayed symptoms.
What happens is that these cases get under-reported because many times the minor injury didn't even register, and may not have been communicated to the medical team when these people arrive at the ER for medical treatment.
This is so sad, since informed medical professionals and informed para-medics and family members could prevent the devastation caused by delayed treatment.
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Update 3/20/2009: Painful new questions tonight about the care Natasha Richardson got and crucially when she got it.
Now that the autopsy has confirmed: Natasha Richardson died of an epidural hematoma, which pushes the brain down onto the brainstem,.... causing massive brainstem damage and death, new questions arise about whether this could have been prevented through timely treatment.
From Anderson Cooper 360:
Richardson died Wednesday of blunt trauma to the head after falling on a beginners ski slope in Canada. Now the resort where the incident happened said the 45-year-old actress was taken to a local hospital about an hour after the accident. But today the ambulance service that was called to the resort disputes that timeline saying Richardson did not arrive at the hospital until nearly four hours after she fell, that's nearly a three-hour difference from what the resort originally said.
These new developments are raising serious legal and medical questions. Could her life have been saved?
Joining us tonight, chief medical correspondent, Dr. Sanjay Gupta, who is a neurosurgeon, and attorney Chris Davis who specializes in medical malpractice and personal injury.
Sanjay, now that we have the full timeline of events after Natasha Richardson's fall, would you say that timing played a role in her death?
DR. SANJAY GUPTA, CNN CHIEF MEDICAL CORRESPONDENT: You know, absolutely. I think when it comes to these types of injuries, where there is blood accumulating underneath the skull, you have to try and operate on these as quickly as possible.
It is tough to give an exact timeline, but if you look at an image like this, and pay attention to that red spot, that red collection of blood starting to form, it has nowhere to go but push down on the brain. The operation that removes something like this is pretty -- relatively simple as far as neurosurgical procedures go but timing is key.
