Natasha Richardson: Fatal Epidural Hematoma from Fall on Beginner’s Ski Slope

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On Monday March 16, 2009 Natasha Richardson, 45, was taking a ski lesson without a helmet (she declined the offer to wear a helmet) on a beginner slope at the Mont Tremblant ski resort north of Montreal, with an instructor. Toward the end of the lesson, Richardson fell and struck her head and the ski instructor called the ski patrol for assistance. She was alert and conversational afterward, even joking about her fall, and did not complain of any ill effects. One hour later, in her hotel room, she developed a severe headache.

Ambulance dispatch records obtained by the New York Times show that Richardson was not hospitalized until almost four hours after suffering the brain injury that ultimately killed her — three hours after developing symptoms.

Yves Coderre, director of operations for Ambulances Radisson, which provided the emergency transport for Natasha Richardson, had told the Toronto Globe and Mail that when paramedics initially arrived 1 p.m. at the Mont Tremblant resort, they were told they were not needed. As they were turned away, paramedics did observe from a distance that Natasha Richardson was sitting on a stretcher at the resort.

The next request for the ambulance for Natasha Richardson, still conscious, came at about 3:00 p.m. followed by a reported “enroute hospital” time of 3:42 p.m. to Centre Hospitalier Laurentien in Ste. Agathe — a 25-mile trip from Mont Temblant.

At 4:20 p.m. Natasha Richardson was examined by a physician.

A transfer was ordered to a larger hospital in Montreal, the Hôpital du Sacré-Coeur de Montréal. Natasha Richardson arrived at the Montreal hospital at about 7:00 p.m. Monday.

Tuesday, Natasha Richardson was accompanied by husband Liam Neeson and flown to Lenox Hill Hospital in New York City in critical condition, where she died on Wednesday after surgery.

Epidural or extradural hematoma (haematoma) is a type of traumatic brain injury (TBI) in which a buildup of blood occurs between the dura mater (the tough outer membrane of the central nervous system) and the skull. The dura mater also covers the spine, so epidural bleeds may also occur in the spinal column. Often due to trauma, the condition is potentially deadly because the buildup of blood may increase pressure in the intracranial space and compress delicate brain tissue. Because the bleed come from an artery the pressure can build up quickly while there is an eye before the storm giving the condition the name ‘Talk and die syndrome.’ The condition is present in one to three percent of head injuries.Between 15 and 20% of patients with epidural hematomas die of the injury. Epidural hematoma is usually found on the same side of the brain as impact.

Skull fractures often accompany epidural hematomas.

Signs & Symptoms of Epidural Hematoma
Expanding hematoma causes headache, nausea, and vomiting. Shifting brain tissue causes local brain dysfunction such as weakness, numbness, or speech problems. If severe progression of the hematoma occurs, central areas of the brain and the brainstem become displaced, causing loss of conscious, abnormal positioning of the arms and legs (decerebrate posture). At this point irreversible brainstem damage can occur. Documentation exists of rapid deteriorating conditions from injury to decerebrate posture in as little as two hours.

Full symptom list in severe head injury:
A lasting headache which worsens, or is still present over six hours following the injury.
Extreme difficulty in staying awake, or still being sleepy several hours after the injury.
Two or more bouts of vomiting.
Unconsciousness, either for a short or extended period of time.
Unequal pupil size.
Straw colored or blood stained fluid coming from the nose or ears. This is cerebrospinal fluid which normally surrounds the brain.
Severe dizziness or loss of balance.
Confusion or strange behavior.
Problems with memory.
Bleeding from the scalp that cannot be quickly stopped.
Not being able to use part of the body, such as weakness in an arm or leg.
Difficulty seeing or double vision.
Slurred speech
Unusual breathing patterns.
Ringing or deafness in one or both ears.
Having a seizure or fit (when your body suddenly moves uncontrollably).

An autopsy revealed that a torn artery bled between the outer lining of the brain and the skull.

Natasha Richardson picture collage.


Bor Seng Shu E, de Almeida Leme RJ, Aguiar PH, de Andrade AF, Teixeira MJ, Plese JP. Traumatic acute giant epidural hematoma in a hydrocephalic shunted child. Pediatr Neurosurg. 2000 Apr;32(4):176-9.

Gerlach R, Dittrich S, Schneider W, Ackermann H, Seifert V, Kieslich M. Traumatic epidural hematomas in children and adolescents: outcome analysis in 39 consecutive unselected cases. Pediatr Emerg Care. 2009 Mar;25(3):164-9.

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