Imagine witnessing a skier fall on a bunny slope, have a conversation, go on her way and then find out she died a few hours later. The death of the actress Natasha Richardson in 2009 was a high profile example of how someone can appear fine after a head injury but sustain life-threatening injuries.
This “walk and die” scenario can occur because of brain bleeds following a trauma. What many people do not realize is that the brain is not attached to the skull. Instead, the brain is surrounded by fluid and literally floats within the skull. Forces exerted upon one’s body can cause the brain to collide with the skull’s interior. Serious head injuries can occur even without direct trauma to the head. For example, a sudden acceleration/deceleration can cause the brain to move inside the skull. This explains how an unsuspecting quarterback can be knocked out during a sack before he hits the ground.
The problem is that once the brain starts to bleed, there is nowhere for the blood and swelling to escape to. A sprained ankle swells outward whereas the skull contains the swelling in a confined area. This creates an ever increasing amount of pressure, which if not addressed, can be fatal. The good news is that a simple CT scan can detect whether the brain is bleeding. The better news is that immediate medical treatment is very effective and often leads to a good recovery.
The hidden dangers of a bleeding brain may not be well known to the public but should be well known to emergency room physicians. Yet, on more than one occasion, I have handled cases where someone went to the emergency room with complaints of headaches or dizziness after hitting her head and then died at home shortly after being discharged. These patients were inexplicably sent home without first undergoing a CT scan despite exhibiting tell-tale symptoms of brain injury such as headaches, nausea, dizziness or confusion. In one case, the patient was on a blood thinner which makes it even more likely that a brain bleed will be fatal. On another occasion, the patient was sent home and instructed to return to the emergency room if the symptoms worsened. This is good advice except it was only provided to the patient, not the patient’s family. A person who has a progressively worsening brain injury cannot be relied upon to follow, or even remember a doctor’s orders.
The bottom line is that if you or someone you know sustains a head trauma and experiences symptoms such as headaches, dizziness or nausea, go to the emergency room immediately. Also, do not assume the emergency room doctor’s failure to order a CT scan means that you are okay. It is important to ask the emergency room physician whether she considered a CT scan and her rationale for not ordering one. Head injuries are serious and require expert care.