Brain
Injuriesheadway
Be careful of
that
bump on the head!
By David Mendelow
Professor of Neurosurgery at Newcastle University
(originally published in the Sunday Post in March 2009)
The tragic death of Natasha Richardson in March 2009,
after a skiing accident in Canada highlights the need for urgent
action with any head injury. She died after what had
appeared to be a fairly minor bump on the nursery slopes, then
apparently declined medical attention and didn't complain of·
feeling unwell until some hours later.
The autopsy, according to the New York City medical examiner,
showed Ms. Richardson suffered an epidural haematoma - known as
an extradural haematoma in Britain which causes bleeding between
the skull and the brain's covering.
Fracture
Such bleeding is often caused by a skull fracture and it can
quickly produce a blood clot that puts pressure on the brain.
That pressure can force the brain downward, pressing on the
brain stem that controls breathing and other vital functions.
Patients with such an injury often feel fine immediately after
being hurt because symptoms from the bleeding may take time to
emerge. This is the so called "lucid interval".
But it is a very treatable condition if the patient is quickly
transferred to a hospital. .
In the UK, with its population of 60 million, there are 3000
haematomas . caused by head trauma - about a quarter of them are
of the types suffered by Natasha Richardson - requiring surgery
every year.
That surgery aims to relieve· pressure on the swollen brain and
remove blood clots: A surgeon will often cut away part of the
skull to allow the brain room to swell. More swelling causes
more damage to the brain, which in turn causes even more
swelling, and being confined inside the skull there's no safety
valve.
So you can see why an operation should be carried out
immediately. Survival rates, which are very good after a
swift operation, decline markedly the longer the delay.
From that point of view it is important that people should be
aware of the signs of possible brain injury - headache,
vomiting, losing consciousness, blurred vision and, sometimes, a
fit.
Anyone whose consciousness is disturbed should be given a brain
scan. The levels of a patient's conscious awareness are measured
by what's known as the Glasgow Coma Scale. It was developed by
the late Professor Bryan Jennet and Sir Graham Teasdale at
the city's Southern General Hospital in 1974.
This scale is now in common use throughout the world and in
Britain there are agreed guidelines from NICE - the National
Institute for Clinical Excellence - on the level at which a CT
scan is required.
There are more than enough scanners throughout the UK to cope
with this and, although about a dozen people die every year from
extradural haematomas, our treatment success rate is quite good.
But there is always room for improvement.
I believe we have mortality from extradural haematomas down to
about two per cent at the moment. Previously it was about 10 per
cent and before CT scanning - pre-1975 - it was almost 50 per
cent in some centres. We should, however, aim for zero
mortality.
One way to help achieve this is for everyone to be aware of
the potential consequences of any bump to the head and to be on
the lookout for the signs and symptoms I mentioned above.
If the public and everyone in the medical profession are alert
to the possible tragic effects of even a minor head-knock then
it will go a long way to getting those fatalities down to
nothing.
So if it's you on the ski slopes this weekend, or even up a
ladder doing a spot of DIY, don't delay if somebody hurts their
head.
Phone NHS 24, phone for an ambulance or get to a hospital.
It's always better to be safe than sorry.