Dr Steve
03-20-2009, 05:53 AM
Look, I don't want to be one of those "experts" who opines about a celebrity tragedy. This is one of those really uncomfortable things for me, and I feel really, really bad for Ms Richardson and her family, especially her husband and kids. You just don't expect a fun outing learning how to ski to end up with you dying that day. But I have had some questions emailed to me about how this could happen and I thought I'd talk about epidural hematomas in general.
Epidural hematoma occurs generally with blunt head trauma. What happens is the artery to the lining of the brain is torn (most often with a skull fracture) and high pressure blood from the artery pours into the area between the skull and the brain causing a blood clot.
http://www.nebraskabraininjurylawyer.com/images/brainoverviews/hematomas/hematoma.epidural.jpg
In about 9% of people, this becomes an unstoppable process, resulting in increased pressure in the brain, resulting in the brain being forced downward. This can cause herniation of the bottom part of the brain through the hole in the base of the skull, which causes immediate cessation of blood flow to the brain.
http://www.uth.tmc.edu/radiology/test/er_primer/skull_brain/fig03.JPG
The mortality of epidural hematomas is estimated to be between 5 and 43%, with fractures over the temple (the thinnest part of the exposed skull) being most likely to result in a bad outcome. Fractures of the temple can indeed be prevented by wearing a helmet.
Epidural hematoma occurs in 1-2% of all head trauma cases and in about 10% of patients who present with traumatic coma. Most people with an epidural hematoma survive and even do well; if it's recognized and treated early, the underlying brain tissue is usually not damaged so no brain damage is expected.
Peoplel with a bleed in the "posterior fossa" (back of the head) often exhibit the classic behavior of feeling "fine" then minutes later being in a coma.
So please, kids, don't think wearing a helmet is fruity. Helmets do save lives. Having said that, this kind of thing is uncommon, though not unheard of. When I was in Vermont we'd have about one person a year die on the slopes from trauma (that's not counting the one or two that died from heart attack every year) if my memory isn't too fuzzy.
your pal,
Steve
Epidural hematoma occurs generally with blunt head trauma. What happens is the artery to the lining of the brain is torn (most often with a skull fracture) and high pressure blood from the artery pours into the area between the skull and the brain causing a blood clot.
http://www.nebraskabraininjurylawyer.com/images/brainoverviews/hematomas/hematoma.epidural.jpg
In about 9% of people, this becomes an unstoppable process, resulting in increased pressure in the brain, resulting in the brain being forced downward. This can cause herniation of the bottom part of the brain through the hole in the base of the skull, which causes immediate cessation of blood flow to the brain.
http://www.uth.tmc.edu/radiology/test/er_primer/skull_brain/fig03.JPG
The mortality of epidural hematomas is estimated to be between 5 and 43%, with fractures over the temple (the thinnest part of the exposed skull) being most likely to result in a bad outcome. Fractures of the temple can indeed be prevented by wearing a helmet.
Epidural hematoma occurs in 1-2% of all head trauma cases and in about 10% of patients who present with traumatic coma. Most people with an epidural hematoma survive and even do well; if it's recognized and treated early, the underlying brain tissue is usually not damaged so no brain damage is expected.
Peoplel with a bleed in the "posterior fossa" (back of the head) often exhibit the classic behavior of feeling "fine" then minutes later being in a coma.
So please, kids, don't think wearing a helmet is fruity. Helmets do save lives. Having said that, this kind of thing is uncommon, though not unheard of. When I was in Vermont we'd have about one person a year die on the slopes from trauma (that's not counting the one or two that died from heart attack every year) if my memory isn't too fuzzy.
your pal,
Steve