Natasha Richardson's tragic death holds lessons
Mon. Mar 23 - THE seemingly minor accident that led to the death of Tony award-winning actress Natasha Richardson on a Quebec ski slope last week was thankfully a rarity. Thatís worth remembering in the aftermath of this tragedy, as entirely reasonable debates continue over mandatory helmet use on ski slopes, helmet quality and the importance of taking potential brain injuries seriously.
Perhaps foremost among the lessons to be learned from this sad incident is that head injuries, no matter how apparently minor, must be handled cautiously until it is clear no serious damage was sustained to the victimís brain.
In Ms. Richardsonís case, it is obvious the ski hillís staff were concerned enough about the severity of the actressís fall on a novice slope during a private ski lesson that they called in the ski patrol. The actress was transported to the bottom of the hill in a rescue toboggan, but refused further medical attention. Resort spokeswoman Catherine Lacasse told the Associated Press on Tuesday that Richardson said she seemed fine at first. "An hour later, she said she didn't feel well. She had a headache, so we sent her to the hospital." Neurosurgeon Levy says that initially there's little brain damage. It's a well-known "lucid interval," he says.
The cause of death, which was ruled an accident, was "epidural hematoma due to blunt impact to the head," said medical examiner spokeswoman Ellen Borakove, the Associated Press reported. An epidural hematoma is a blood clot that pools between the brain and the skull. In these cases, the patient has what is referred to as the golden hour to receive treatment and surgery.
A "fair-sized" epidural hematoma would be about 3 ounces of blood, says Eugene a small clot will do more harm," Flamm says. Flamm and Levy say an epidural hematoma is easy to diagnose on a CT scan, and neurosurgeons usually treat it by cutting out part of the skull to remove the excess blood. It isn't known whether Richardson had the surgery. "This is a very treatable condition if you're aware of what the problem is and the patient is quickly transferred to a hospital," Keith Siller of New York University Langone Medical Center told the Associated Press.
Such a fall could have occurred anywhere, in a wide variety of circumstances. What doctors call the "talk and die" syndrome, in which victims initially feel fine and then quickly succumb to unseen trauma to the brain, means that seeking medical attention quickly after head injuries is critical to survival. Obviously, not every knock to the head requires a trip to the hospital.
Whatís important is that anyone suffering a significant blow to their head, and those who are with them, err on the side of caution if there is any sign of trouble, including headache, confusion or drowsiness. In Ms. Richardsonís case, her injury Ė bleeding between the brainís covering and the skull that built up pressure on the brain and led to a coma and her death Ė sadly could have been treated if her condition would have been discovered earlier.
Should helmets be mandatory for everyone on all ski hills? The Brain Injury Association of Oregon thinks so. We also think that there should be a mandatory ski helmet rule for anyone under age 18. Regardless, ski hills everywhere would be wise to insist that anyone, child or adult, taking ski lessons wear protective headgear, and encourage everyone else Ė especially in light of what happened to Ms. Richardson Ė to also don helmets. Most hills already make helmets mandatory for ski schools and within all special terrain areas, such as the halfpipe, for snowboarders.
Finding may prevent long-term harm that often follows brain injury, researcher says
SUNDAY, March 15 (HealthDay News) -- A new class of Alzheimer's disease drugs may prevent long-term damage from traumatic brain injury, suggests a study of mice by Georgetown University Medical Center researchers. The drugs -- gamma-secretase inhibitors -- are designed to target amyloid plaque that accumulates in the brains of people with Alzheimer's disease, according to background information in the study. "No one knows why it occurs, but abnormal amounts of amyloid plaque have been found during an autopsy in about a third of brain injury victims, some of whom were children who would ordinarily never have had these deposits," Mark Burns, a neuroscientist and assistant professor at Georgetown and the study's lead author, said in a university news release. "Remarkably, these deposits occur in less than one day after injury." It's also known that people who've suffered a brain injury have a 400 percent increased risk of developing Alzheimer's disease, according to the researchers. "In this study, we show that the same pathways activated chronically in Alzheimer's disease are activated acutely in traumatic brain injury and that they appear to play a very important role in secondary injury," Burns said. He and his colleagues first conducted tests that showed that brain injury in mice resulted in substantially more amyloid peptide than normal. They then found that amyloid peptide production after brain injury was reduced in mice that received an experimental agent called DAPT, one of the first gamma secretase inhibitors developed and the basis for some Alzheimer's disease drugs now in clinical trials. The researchers said that their findings, which are published online in Nature Medicine, suggest that this class of drugs could do something no other drug has been able to do -- prevent the long-term and continuing damage that often follows serious brain injury. "This is an exciting finding that we hope can be readily tested in patients with traumatic brain injury," Burns said. Georgetown University has applied for a patent for the technology involved in the research, the news release said.
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CLOONEY CONTEMPLATED SUICIDE OVER BRAIN INJURY
Hollywood heart-throb GEORGE CLOONEY considered suicide to escape the horrific pain he experienced after suffering a brain injury while filming forthcoming movie SYRIANA.
The 44-year-old star battled excruciating headaches and serious memory loss after an accident which occurred on the set of the Middle Eastern thriller.
Doctors initially struggled to identify the problem, but a neurologist eventually discovered the severity of his injuries and Clooney immediately underwent a series of operations to banish his headaches.
He says, "Before the surgery it was the most unbearable pain I've ever been through, literally where you'd go, 'Well, you'll have to kill yourself at some point, you can't live like this.'
"There was this scene where I was taped to the chair and getting beaten up. The chair was kicked over and I hit my head.
"I tore my dura, which is the wrap around my spine that holds in the spinal fluid. But it's not my back; it's my brain. I basically bruised my brain.
"It's bouncing around my head because it's not supported by the spinal fluid."
During his recovery, the OCEAN'S ELEVEN actor has been encouraging his memory to return by doing repetitive counting exercises, and describes the last 12 months as the "worst year I've ever had".
October 23, 2005
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