MEDICAL MATTERS:The tragic death of Natasha Richardson has led to a debate on the safety of skiing, writes MUIRIS HOUSTON.
THE RECENT death of Natasha Richardson, following a relatively minor head injury sustained while learning to ski, has really shocked people. Her death has led to internet and media conversations about the safety of skiing, whether wearing a helmet might have saved her life and the risk of death from head injury.
The award-winning actress was being taught to ski on a relatively flat slope on Mont Tremblant, Quebec when she suffered a minor fall and banged her head on the snow. She was not wearing a ski helmet. The actress got up straight away and declined medical assistance.
About one hour later she complained of a headache. By the time a medical team arrived she was conscious but was clearly unwell. But she was pronounced brain dead at the Montreal hospital she was brought to.
While rare, the rapidity of Richardson’s deterioration is not without precedent. Sometimes referred to as a “walk and die” head injury – because a person can feel fine, show no symptoms and yet have bleeding into the brain – by the time symptoms develop it can be too late. This is especially the case if the bleeding occurs at the base of the brain.
It is likely that Richardson suffered a traumatic sub-arachnoid haemorrhage. Arachnoid means spider-like and refers to the delicate web-like covering of the brain and spinal cord. The bleed can be small and localised, or it can take the form of a large diffuse clot. The most common spontaneous cause of subarachnoid haemorrhage is rupture of an aneurysm in the brain.
An aneurysm is a bulging in a vessel, like the swelling sometimes seen in tyres, which has the potential to enlarge and eventually burst.
Another kind of haemorrhage, most commonly associated with head trauma, is a subdural bleed. The dura is the tough outer membrane that encases the brain and spinal cord.
Usually the result of torn veins, it may take some days for symptoms such as confusion and loss of power to occur. Because of their location outside the brain, subdural clots can be drained by boring into the skull. This relieves the pressure on the brain, often with a striking reduction in symptoms.
Brain injury accounts for 2-8 per cent of reported ski injuries. One expert has estimated there is one medically significant injury for every 400 ski days. This puts skiing on a par with cycling and scuba diving in injury risk terms.
Even though some 43 per cent of skiers and snowboarders in the US wore helmets in the 2007/2008 season, the rate of accidental deaths on the slopes has not changed with increased usage. There was 53 ski-related deaths in the US last year.
It has also been suggested that wearing a ski helmet gives amateur skiers a false sense of security.
But a 2005 Canadian study, coincidentally carried out in Quebec, found that helmets did protect skiers and snowboarders against head injury.
The well-designed study, which matched those with head and neck injuries sustained between November 2001 and April 2002 with other skiers, found those who wore a helmet had a 29 per cent reduction in the risk of head injury.
A Denver Colorado study seems to back up this conclusion. Of 261 skiers and snowboarders admitted to hospital over six seasons just 13 wore helmets. But among those who didn’t wear a helmet, a majority suffered severe injuries such as bruising to the brain, or a subdural clot, and 4 per cent died.
Might Natasha Richardson have survived if she was wearing a helmet? It is impossible to say with certainty. Based on the information available, it is possible to say that Richardson may have had an underlying cerebral aneurysm in her brain.
Such an aneurysm could have blown spontaneously at a later time without head trauma. And it is entirely possible she could have taken the anomaly to the grave without it ever having manifested itself during her life.
For anyone now fearful of skiing the advice is: don’t be. Consider wearing a helmet, ski responsibly and enjoy the exercise and the healthy air.
Dr Houston is please to hear from readers, but regrets he is unable to reply to individual medical queries.