When to Seek Medical Attention for a Head Injury

Originally published in March 2009

In the wake of the tragic passing of actress Natasha Richardson, I'd like to share a few details on head injuries that everyone should know about.

Based on what I've read in several newspaper reports, Natasha Richardson died from an epidural hematoma, which medical professionals will tell you is one of the most frightening conditions around because it can be caused by a low force blow to the head, and also because initially, there may be no signs to indicate that a serious injury has occurred.

Understanding Epidural Hematomas

Your brain is surrounded by three thin layers of connective tissue that are collectively called your meninges. The outermost meningeal layer is called dura mater, and the thin space between your dura mater and the bones that make up your skull is called your epidural space.

Along the sides of your head in the area around your temples, your epidural space houses an artery called your middle meningeal artery, whose job is to provide steady blood supply to your meninges. The portion of skull that protects this area is quite thin and weak compared to the rest of your skull. This is why even a low force blow to this area could lead to a fracture and tearing of your middle meningeal artery.

If your middle meningeal artery was torn or lacerated, blood could quickly begin to pool in your epidural space. Because your heart would continue to send blood to the area and this blood wouldn't be drained by your veins, the net effect of a torn middle meningeal artery would be increased pressure on your brain tissues, which could lead to death of brain cells from oxygen deprivation.

Symptoms and Common Causes of Epidural Hematomas

About 50% of people who experience epidural hematomas briefly lose consciousness, but appear to be just fine when they come to. If pressure in the head continues to build, over a period of a few hours, a searing headache tends to develop as increased intracranial pressure causes the dura mater to tear away from the skull.

Other signs and symptoms that may develop with an epidural hematoma include:

• Lethargy

• Nausea

• Dizziness

• Drowsiness

• Weakness on one side of the body

The keys to preventing serious brain damage and death from an epidural hematoma is to recognize what has happened, and for the blood to be aspirated by a neurosurgeon.

I have long recommended that any person who suffers a blow to the side of the head - especially in the temple region - be carefully monitored for any of the signs noted above, and to be ready to visit an ER immediately, accompanied by someone who can explain what has happened.

Common causes of epidural hematomas include:

• Skiing and snowboarding falls that involve head trauma. According to the American Association of Neurological Surgeons, 1.5 million Americans suffered brain injuries in 2007, and more than 10,000 of these injuries occurred while skiing or snowboarding.

• Violent blows to the head during physical altercations.

• Motor vehicle accidents.

Clearly, if you ever take part in an activity where there's a strong chance that you could experience a blow to your head, it's wise to wear a helmet. And there's nothing prissy about making the decision to avoid high risk activities like boxing, high speed skiing, and high level contact sports like football and hockey.

Please note that there are many different forms of internal bleeding that can occur in the skull, and epidural hematomas can arise from tears or lacerations of arteries other than the middle meningeal artery.

Another major type of internal bleeding in the head is a subdural hematoma, where the bleeding occurs below the dura mater. Subdural hematomas are a leading cause of brain injury and death in battered children - direct blows by a care-giver's hand, a child's head being smashed against a hard object, or violent shaking of a small child can all lead to serious injury and death through internal bleeding.

In all cases of head injuries, the warning to heed remains the same: If you suffer a blow to the head, even if you feel fine immediately afterward, stay alert for signs of discomfort and consider being evaluated by a physician if you feel anything out of the ordinary - even a mild headache that comes on after experiencing blunt force to your head should not be ignored.

Please share this information with all parents and grandparents in your life; being aware of this while caring for youngsters is a good thing.