Natasha Richardson and Head Injuries: Know the Warning Signs

In what's being called a "freak skiing accident," actress Natasha Richardson apparently suffered a devastating brain injury on Monday that, it appears, she won't recover from. The latest news reports say that Richardson is brain dead and that her friends and family are gathering at her side today to say their goodbyes.

Let me first point out that Richardson's brain injury reportedly occurred on a beginner's ski slope, while she was having a private lesson with an instructor. She wasn't heli-skiing off some dangerous ledge in the middle of nowhere. And, according to authorities at the ski resort, she took all the proper precautions after being injured. Although she didn't even have a concussion, she was immediately examined by a physician and then taken to a hospital after she developed a severe headache.

I can't help thinking about my 13-year-old daughter—also a novice skier—who just went on a class ski trip. She didn't have a lesson and went down intermediate slopes. Should I have been worried about her safety?

"I think we need to put this a little in perspective," says Keith Black, chairman of the department of neurosurgery at Cedars-Sinai Hospital in Los Angeles. "This is quite an unusual circumstance." Though not familiar with Richardson's medical history, he wonders whether she may have had a pre-existing condition that caused excessive bleeding in her brain. "Taking blood thinners like aspirin or even fish oil can cause an abnormal amount of bleeding after a head injury," he tells me. Or she may have had an unusual tangle of blood vessels near her brainstem, the vital area that controls breathing and heart rate; if that tangle ruptured from a blunt force, it could have caused a massive stroke, quickly and permanently shutting down her brain function. "Some of these conditions can make a minor injury catastrophic," explains Black.

These sorts of things are just a bad roll of the dice—beyond anyone's control. But the vast majority of the time, taking the proper precautions after a brain injury can increase your odds of walking away unscathed.

Go to the emergency room immediately, Black says, if you have any of these symptoms after a head trauma:

• Numbness
• Excessive drowsiness
• Headache
• Weakness in your arms or legs
• Dizziness or loss of vision
• Slurred speech
• Loss of consciousness or confusion
• Vomiting or nausea

A complete workup for these symptoms should include either an X-ray or CT scan of the brain to look for bleeding or signs of a stroke. If a blood clot is found, clotbuster drugs are often the treatment of choice. Brain bleeds are usually monitored to see if pressure builds up, which could necessitate surgery. "We usually like to observe the patient for 24 hours even if we don't see anything wrong at first," Black says, "since problems can sometimes develop hours later." He also emphasizes that most of the time, when these conditions are caught promptly, they have good outcomes.

Unfortunately, Richardson may have been one of the outliers, critically injured despite doing everything right after the accident. But could she have prevented this by wearing a helmet? (According to People , she wasn't wearing one.) While it's certainly a good idea for all skiers to wear one, it's unclear whether it would have made a difference. "If this was a neck injury, it wouldn't have protected her from that," Black says. Sometimes fate just steps in. "I obviously wish the best for her," he adds, "and give my sympathy to her family." As do we all.

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