They fall, they feel OK... and then some victims dieAt first, Natasha Richardson felt fine after she took a spill on a Canadian ski slope. But that’s not unusual for people who suffer traumatic head injuries like the one that killed the actress.
At first, Natasha Richardson felt fine after she took a spill on a Canadian ski slope. But that’s not unusual for people who suffer traumatic head injuries like the one that killed the actress.
In “talk and die” syndrome, doctors say, patients with brain injuries sometimes can have what’s called a “lucid interval” where they act fine for an hour or more as the brain slowly, silently swells or bleeds. Later, back at her hotel, Richardson became ill, complained of a headache and was taken to a hospital. She died Wednesday in New York.
“It is not a very common occurrence,” said Dr. Steven Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at New York University Langone Medical Center. “A patient comes into the emergency room talking and then rapidly deteriorates” as blood pools and puts pressure on brain tissue.
An autopsy Thursday showed that the 45-year-old actress suffered a blow to the head that caused bleeding between the skull and the brain’s covering, called an epidural hematoma. Usually caused by a trauma such as a fall, blood builds up between the cover of the brain, called the dura, and the skull.
Blood trapped inside the “closed box” of the skull can compress brain tissue, which can cause pressure on vital functions, said Dr. Henry Woo, associate professor of neurological surgery and radiology at Stony Brook University Medical Center.
Because of that lucid interval, doctors always tell patients who seem OK after a brain injury to have someone keep a close eye on them, in case symptoms emerge.
Symptoms — headache; loss of consciousness; vomiting; problems seeing, speaking or moving; confusion; drainage of a clear fluid from the nose or mouth — appear after enough pressure builds in the skull. By then it’s an emergency.
“Once you have more swelling, it causes more trauma which causes more swelling,” said Dr. Edward Aulisi, neurosurgery chief at Washington Hospital Center in the nation’s capital. “It’s a vicious cycle because everything’s inside a closed space.”
A CT scan can detect bleeding, bruising or the beginning of swelling after an injury. The challenge is for patients to know whether to seek one.
“If there’s any question in your mind whatsoever, you get a head CT,” Aulisi advised. “It’s the best 20 seconds you ever spent in your life.”
Descended from one of Britain’s greatest acting dynasties, including her mother, Vanessa Redgrave, Richardson was known for her work in such plays as “Cabaret” (for which she won a Tony) and “Anna Christie,” and in the films “Patty Hearst” and “The Handmaid’s Tale.”
Mourning continued Thursday with Broadway theaters planning to dim their lights in Richardson’s honor at 8 p.m., the traditional starting time for evening performances.
Praise also came from both tabloid celebrities such as “The Parent Trap” co-star Lindsay Lohan and theater artists like Sam Mendes, who directed the 1998 revival of “Cabaret.”
“It defies belief that this gifted, brave, tenacious, wonderful woman is gone,” said Mendes, who also directed the Academy Award-winning “American Beauty.”
Richardson gave several memorable stage performances, more than living up to some of the theater’s most famous roles: Sally Bowles of “Cabaret,” Blanche DuBois of “A Streetcar Named Desire” and the title character of Eugene O’Neill’s “Anna Christie,” a 1993 revival in which she co-starred with future husband Liam Neeson. They have two sons: Micheal, 13, and Daniel, 12.
Newsday and the Associated Press contributed to this report.