A Devastating Injury

The most common head injury after a fall, or while playing sports, is a minor concussion. In rare cases, the trauma of hitting your head can have dire consequences, including bleeding and swelling of the brain. In some instances, these injuries aren't immediately apparent because the patient may initially be lucid and without serious symptoms. (Article continued below...)

Actress Natasha Richardson's recent skiing accident appears to be one of these unusual and tragic situations. The Tony Award-winning wife of actor Liam Neeson fell during a ski lesson on a beginner slope at a Canadian resort on March 16. At first, she showed no signs of major injury and was even joking about the incident, according to media accounts. But within hours, her health deteriorated and the 45-year-old mother of two was hospitalized and then subsequently transferred to a New York hospital.

Dr. Stephan Mayer, head of the Neurocritical Care Unit at Columbia University Medical Center, spoke with NEWSWEEK's Dina Fine Maron about how a seemingly minor fall could become a life-threatening emergency and what to watch for after any head trauma. Excerpts:

NEWSWEEK: What's the difference between an ordinary bump on the head, and an injury that may not appear to be serious at first but is potentially critical?
Stephan Mayer: The most common thing that happens is that a fall shakes the brain and it then manifests as a concussion. Concussion is a syndrome of a temporary lapse of consciousness triggered by trauma. That's where you pass out or you see stars or are generally zonked out when people talk to you. But a concussion by definition is a brief or temporary disruption of the brain. Concussion never lands you in an intensive-care unit.

A possibility [in accidents similar to what reportedly happened to Natasha Richardson] is that the fall triggered a syndrome of delayed massive brain swelling. In fact, being in an area with low oxygen like on top of a mountain, might actually increase that chance.

How can doctors make a diagnosis of a serious brain injury when the patient doesn't have symptoms immediately?
Through a different mechanism than concussions, trauma can rarely trigger a delayed and more sinister reaction or form of injury. These more sinister life-threatening situations occur in two ways: huge swelling of the brain or bleeding on the surface of the brain—both would have an abnormal CAT scan. [After a fall] there is commonly a lucid interval where you may seem fine for an hour or two and then may develop symptoms of a more urgent nature unless something is done to reverse it ... like surgery. We've known this forever. That's why you observe someone for the next hour or two after a fall.