Richardson Died From Clot That Compressed Brain

An unidentified man carries flowers into Natasha Richardson's apartment building in New York.
An unidentified man carries flowers into Natasha Richardson's apartment building in New York. (By Joe Corrigan -- Getty Images)
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By David Brown
Washington Post Staff Writer
Friday, March 20, 2009

Natasha Richardson, the British actress who fell during a ski lesson on Monday and later in the day lapsed into a coma, died of a large blood clot compressing her brain, New York City's medical examiner said yesterday.

The bleeding that led to the clot was caused by "blunt impact to the head," according to the official report, which also labeled the death an accident.

The formal name for the condition is "epidural hematoma." It is usually the result of bleeding from arteries torn when the skull is struck hard, often on the temple where the bone is thinnest.

Arterial hemorrhage inside the skull is a potential catastrophe. Each heartbeat pumps blood under high pressure into a confined space, compressing the brain tissue.

"It is the most feared, treatable problem in neurosurgery," said Gail Rosseau, chief of surgery at the Neurologic and Orthopedic Hospital of Chicago. "These are the patients who 'talk and die.' "

If the condition is recognized in time, a surgeon can drill a hole through the skull or cut away a piece of it, remove the clot and relieve the pressure. This often results in complete recovery.

Although many details of Richardson's accident have not been made public, she apparently demonstrated a "lucid interval" typical of many traumatic epidural hematomas -- a period soon after the impact when the victim is alert and feels well that is followed by a rapid decline into unconsciousness.

The Toronto Globe and Mail newspaper reported Wednesday that an ambulance was dispatched to the Mont Tremblant ski resort in Quebec on Monday but "turned around" when paramedics were told they were no longer needed. Richardson reportedly went back to her hotel to rest. When her condition began to deteriorate, another ambulance was called.

Where and when she first got a computerized axial tomography, or CAT, scan, the usual way subdural hematomas are discovered, was not known.

The actress was first taken to Centre Hospitalier Laurentien, in Sainte-Agathe-des-Monts, 25 miles from the ski area, arriving shortly after 4 p.m., said hospital spokesman Alain Paquette. That hospital does not have neurosurgical services, so she was stabilized and transferred by ambulance two hours later to Hôpital du Sacré-Coeur, a trauma center 50 miles away in Montreal.

She was ultimately flown to Lenox Hill Hospital in New York, where she died Wednesday at 7:26 p.m.

The Montreal hospital gave no details yesterday about Richardson's treatment.

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