Be careful of
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.
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.