Natasha Richardson died of hematoma
Actress fell during ski lesson on MondayNEW YORK -- Natasha Richardson died from bleeding in her skull caused by the fall she took on a ski slope, an autopsy found Thursday. The medical examiner ruled her death an accident, and doctors said she might have survived had she received immediate treatment.
Richardson suffered from an epidural hematoma, which causes bleeding between the skull and the brain's covering, said Ellen Borakove, a spokeswoman for the New York City medical examiner's office.
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 a very treatable condition if you're aware of what the problem is and the patient is quickly transferred to a hospital," said Dr. Keith Siller of New York University Langone Medical Center. "But there is very little time to correct this."
To prevent coma or death, surgeons frequently cut off part of the skull to give the brain room to swell.
"Once you have more swelling, it causes more trauma which causes more swelling," said Dr. Edward Aulisi, neurosurgery chief at Washington Hospital Center in the nation's capital. "It's a vicious cycle because everything's inside a closed space."
Richardson, 45, died Wednesday at Lenox Hill Hospital in Manhattan after falling at the Mont Tremblant resort in Quebec on Monday. Details of her treatment have not been disclosed.
It remained unclear Thursday exactly how she was injured. Resort officials have said only that she fell on a beginner's trail and later reported not feeling well.
A CT scan can detect bleeding, bruising or the beginning of swelling in the brain. The challenge is for patients to know whether to seek one.
"If there's any question in your mind whatsoever, you get a head CT," Aulisi advised. "It's the best 20 seconds you ever spent in your life."
Descended from one of Britain's greatest acting dynasties, including her mother, Vanessa Redgrave, Richardson was known for her work in such plays as "Cabaret" (for which she won a Tony) and "Anna Christie" and in the films "Patty Hearst" and "The Handmaid's Tale."
Mourning continued Thursday with Broadway theaters planning to dim their lights in Richardson's honor at 8 p.m., the traditional starting time for evening performances.
Richardson gave several memorable stage performances, more than living up to some of the theater's most famous roles: Sally Bowles of "Cabaret," Blanche DuBois of "A Streetcar Named Desire" and the title character of Eugene O'Neill's "Anna Christie," a 1993 revival in which she co-starred with future husband Liam Neeson.
The death of Richardson, who was not wearing a helmet, greatly heightened the debate over skiing safety. In Quebec, officials are considering making helmets mandatory on ski hills.
Jean-Pascal Bernier, a spokesman for Quebec Sport and Leisure Minister Michelle Courchesne, said Thursday that the minister met with emergency room doctors this week and will meet with ski hill operators soon.
Emergency room doctors in the province first called for mandatory use of helmets three weeks ago.
Questions also arose about why the first ambulance called to the ski resort was turned away.
Yves Coderre, director of operations at the emergency services company that sent paramedics to the Mont Tremblant resort, told The Globe and Mail newspaper Wednesday that the paramedics were told they were not needed.
"They never saw the patient," Coderre said. "So they turned around."
Coderre said another ambulance was called later to Richardson's luxury hotel. By that point, her condition had worsened, and she was rushed to a hospital.
Richardson said she felt fine after her spill but became ill later and complained of a headache. Doctors say sometimes patients with brain injuries have what's called a "lucid interval" in which they act fine for an hour or more as the brain slowly, silently swells or bleeds.
Symptoms such as a headache, confusion, vomiting or difficulty seeing, speaking or moving appear after pressure builds in the skull.
Emergency surgery is often need to drain the blood or remove the clot.