We all take it for granted that, “it will never happen to us”. Especially here in Colorado’s ski country, Natasha Richardson’s recent death due to a head injury sustained during a private ski lesson is a grim reminder that no one is immune from the dangers of a traumatic head injury. During a beginner level ski lesson in Canada, Richardson took a seemingly minor tumble, and then walked off the slope to her hotel. Less than an hour later, after complaining of a severe headache she was rushed to a local hospital and later died of her head injury.

While Richardson’s death seems to be an extremely rare case, possibly talk and die syndrome, it begs the question; how could a simple fall turn deadly?

According to Dr. Keith Black, chairman of the Department of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles, in an interview by Scientific American,

The possibilities range from what we call an arterial dissection to a preexisting condition that might have been triggered by the event. An arterial dissection is where patients have a very mild injury tear the inner lining of the arteries of the neck, either the carotid or vertebral arteries, and that can occur with even minor trauma that one may not believe to be significant. That tearing in the artery can cause clotting, which can set up a stroke (an interruption of the brain’s blood supply caused by a blockage or a rupture of a blood vessel). If that clot is in the vertebral artery system, it can cause a stroke in the brain stem, which can be devastating.

The other possibility is delayed bleeding in the brain. That can be from either a tear in a vein or an artery in the brain tissue itself, and that can be either an epidural hematoma (between the skull and the dura, the membrane that surrounds the brain) or a subdural hematoma (between the dura and the brain).

Another possibility is that she had a condition that predisposed her to having a more catastrophic event. This could be an abnormality in how fast her blood clots after a bleed. Or if she’s been on any aspirin, blood thinners, or, supplements like omega-3 fish oil that can make things worse. The other thing one has to worry about is whether she had a vascular abnormality in the brain like an arteriovenous malformation (an abnormal connection between high-pressure arteries and low-pressure veins). If an AVM tears one can get a more significant bleed.

While there has been some debate as to whether or not wearing a helmet might have saved Richardson, erring on the side of safety is always a good thing, especially with our children.

Our sympathy goes out to the family and friends of Natasha Richardson. Let her death be a reminder to be careful out on the slopes and if you do suffer a head injury, no matter how minor it seems at the time, go see a doctor immediately and get it checked out.