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Brain injury group schedules walk

SAN DIEGO -- The Brain Injury Foundation hosts its second annual Statewide Walk for Thought on Saturday. Each walk is approximately three miles and participants are encouraged to go at their own pace. Registration begins at 8 a.m. at De Anza Cove, Mission Bay Park, 3000 E. Mission Bay Drive. Cost is $25 adults, $15 for ages 5-16, and free for infants to 4 years. Register online at calbia.org.

Actress Natasha Richardson's skiing accident is raising questions of how a seemingly simple fall apparently led to her death.

She reportedly suffered a head injury from the fall during a private ski lesson at a resort in Quebec, and died Wednesday after being flown to New York City for treatment.

The New York City medical examiner's office said the death was ruled an accident, "epidural hematoma due to blunt impact to the head."

According to the resort, Richardson, 45, said she felt fine after the accident but later fell ill and complained of a headache. Doctors say sometimes patients with brain injuries have what's called a "lucid interval" where they act fine for an hour or more as the brain slowly, silently swells or bleeds.

The lucid interval is why doctors always advise keeping a close eye for up to 24 hours on someone who seems OK after a head injury, in case symptoms emerge.

Symptoms of a traumatic brain injury -- 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."

Pressure great enough can force the brain downward to press on the brain stem that controls breathing and other vital functions, causing coma or death. Frequently, surgeons cut off a portion of the skull to give the brain room to swell.

Even simple bruising of the brain can trigger swelling. Trauma also may cause bleeding between the skull and the brain's covering, called an epidural hematoma. Sometimes a torn artery goes into a spasm, temporarily stopping bleeding and delaying the hemorrhage, that lucid period. Bleeding requires emergency surgery.

An epidural hematoma is the most likely scenario in Richardson's case, said Dr. Keith Siller of New York University Langone Medical Center.

"This is a very treatable condition if you're aware of what the problem is and the patient is quickly transferred to a hospital," he said. "But there is very little time to correct this."

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."