Monday, March 23, 2009

A classic 'talk and die' case: Doctors

A classic 'talk and die' case: Doctors
Mon, Mar 23, 2009
The Straits Times

THE death of British actress Natasha Richardson after a fall has highlighted the fact that head injuries which seem minor at first can become fatal.

The patient can feel fine, walk and talk immediately after the fall. But within hours, he may lapse into a coma and die.

That apparently was what happened to Ms Richardson, 45, who died in New York on Wednesday, two days after she fell while skiing at the Mont Tremblant resort in Quebec, Canada.

She landed on snow, had no visible injury and simply got to her feet, laughing and joking, according to witnesses quoted in media reports.

It was only hours later that she complained of a headache.

Neurologists said this was a classic 'talk and die' case.

A spokesman for the New York City medical examiner's office was quoted by the Associated Press as saying that the actress had an epidural haematoma - bleeding inside the skull.

It is usually the result of bleeding from arteries torn when the skull is struck hard.

This can quickly produce a blood clot that puts pressure on the brain and can force the brain downward, pressing on the brain stem that controls breathing and other vital functions.

Dr Alvin Hong, a neurosurgeon, told The Straits Times that when the clot is small, the patient may be conscious. But as it grows, a severe headache develops and then the person becomes drowsy, goes into a coma and dies. How quickly a person's condition deteriorates depends on how fast the clot grows.

That is why the first hours are crucial. Doctors advise those who fall during high-impact sports - such as skiing, roller-blading or skate-boarding - to seek medical treatment immediately. In Ms Richardson's case, nearly four hours passed before she was admitted to a hospital.

According to AP, the first emergency call was at 12.43pm on Monday and medics arrived 17 minutes later. But Ms Richardson refused medical aid.

At 3pm, a second emergency call was made from her hotel room and an ambulance arrived nine minutes later. The medics tended to her for half an hour before taking her to a hospital that was 40 minutes away. She was moved to New York on Tuesday.

Neurosurgeon Prem Pillay, referring to the precious hours lost, said: 'The brain died from the pressure of an enlarging clot.'

A CT scan can detect bleeding, bruising or the beginning of swelling in the brain. Neurosurgeons operate to remove the clot. But surgery is needed quickly, ideally within an hour.

Dr Pillay said: 'Wearing a safety helmet when taking part in extreme sports can save lives.'

This article was first published in The Straits Times.

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