From Our 2009 Archives
Natasha Richardson Dies of Epidural Hematoma
New York City Medical Examiner Issues Report on Cause of Death
By Daniel J. DeNoon
Reviewed by Louise Chang, MD
March 19, 2009 -- The seemingly mild head injury that killed actress Natasha Richardson was an epidural hematoma, the New York City medical examiner's office announced today.
The death was ruled an accident. Richardson was reported to have slipped and fallen while taking a skiing lesson at a Canadian resort. Although she is said to have appeared unhurt, she later developed a headache and was taken by ambulance to a hospital.
That's entirely consistent with the diagnosis of epidural hematoma, says Eugene Flamm, MD, chairman of neurosurgery at Montefiore Medical Center and Albert Einstein College of Medicine, New York.
The dura is the membrane between the brain and the skull. If blood collects in the area in between, it presses harder and harder against the brain. Eventually it causes herniation: the whole brain shifts.
"When something large makes the brain shift, the blood supply gets cut off and the whole brain dies," Flamm says.
Flamm did not examine Richardson, and he is quick to note that his comments on her case are speculation based on media reports. But Flamm has treated many patients with similar case histories.
"If someone has a significant-size epidural hematoma that you can see on a CAT scan , you would operate and remove it," he says. "Sometimes you see a smaller one, and I don't operate. But that is rare -- I usually operate because of the potential for the brain moving and putting pressure on a vital structure."
From media reports, Flamm speculates that Richardson was already brain dead by the time she reached a local hospital -- well before she was flown to New York.
Despite Richardson's death, Flamm notes that an epidural hematoma is not always fatal and may not even cause lasting brain damage.
"It all depends on how severe the neurological problem is at the time of surgery," he says. "If a patient is deeply comatose, it is more serious than if the symptom is just sleepiness or pain on the side of the head. If there has not been a lot of brain damage, there can be full recovery."