Until I read otherwise, I am betting that there was a blood vessel that tore and it was the brain hemmorhage that killed her. If that is so, only an immediate operation to relieve the pressure would have saved her and I am not sure that was available. Maybe a helicopter to Montreal would have been in time, but there was no reason to guess that was necessary.
What scares the crap out of me is that I fell and busted my ass on the snow on the sidewalk a few weeks ago, and I bopped my head when I did it. I didn’t go to the Dr. until a few days later, and that was just to make sure I didn’t break anything in my back, not anything to do with my head.
Now for me, it just turned out to be a bop on the head like one occaisionally gets and thinks nothing of. The same thing could’ve happen to me as happened to her.
These accidents are really quite terrifying to think about. It reminds me Brittanie Cecil, a 13-year-old hockey fan who was struck by a stray hockey puck during a game. The force snapped her neck back with incredible force, but she ended up walking out of the arena that night and made a visit to a hospital. Even then, a CT-scan failed to catch a damaged artery in her brain, resulting in severe clotting and swelling. Two days later, she died, suddenly.
Yeah, this is why I always wear a helmet on my bike. When accelleration due to gravity just falling has enough force to kill you (Remember Dr. Atkins, the low-carb guy, died after slipping on the ice) adding 5-15mph to that impact is not going to help.
No meaningful information has been released, so this is just speculation, but . . .
It was drilled into us in med school that when someone hits their head, and then is fine for a short period, and then suddenly crashes, you are probably dealing with an epidural hematoma. As the Wiki article notes, this refers to a torn artery. Arteries bleed with high pressure, so in the closed box which is your skull, the pressure will increase rapidly. As a result, parts of the brain get pushed out through the hole at the bottom of the skull, i.e. through the foramen magnum (cerebellar tonsillar herniation), or one part of the brain is pushed onto another (uncal herniation). Both are rapidly fatal.
Here is the Wiki article on various types of brain herniation.
(Note the last few sentences of the “Features” section of the Wiki article on epidural hematoma which discuss the so-called “lucid interval”)
I think most of the points have already been covered. Just to add:
Injury without a blow: definitely possible, as related upthread about Brittanie Cecil. “Headbanging” by disco dancers has been known to result in severe head injury. The cerebrospinal fluid has enough cushioning effect to take care of most normal shakes of the head etc. though.
A simple fall can cause a serious head injury if the victim does not protect herself. imagine a person falling onto her back with her arms otherwise occupied, say with ski sticks. You have a five to six foot lever with a hard round object at the top falling with tremendous angular momentum. There is a sudden stop and then an acceleration/deceration injury occurs as described upthread. The brain hits the stopped skull, then again is hit by the opposite side coming down.
There is not yet sufficient information available to describe the mode of injury in this case, but the type I have postulated is common, apparently trivial, and can be serious.
The brain has no pain receptors. it is possible to injure the brain without feeling pain. Headache is due to inreased intracranial pressure stretching the dura mater surrounding the brain and its supplying blood vessels, which do have a nerve supply.
The base of the front of the skull is rough in contour. In an anterior-posterior injury the base of the brain may catch against its protuberances, leading to multiple small contusions. initially the patient may feel nothing. But each contusion is an area of torn, if small, blood vessels, which may continue to leak. In addition, every area of trauma is prone to reactive swelling. Anyone who has had an injury to the fae will realise that the softer tissues (lips, eyelids) swell more. The brain, as has been stated, is soft. There is correspondingly more swelling with trauma. The skull is a closed box with no escape route. If there is sufficient brain swelling, the intracranial pressure rises and the blood supply to the brain is impaired. This is what leads to unconsciousness, and if severe, to death.
Something like this is probably what happened here. A major vessel bleed would have led to a blood clot causing the problem which could have been evacuated. With massive brain swelling, probably on both sides, this is not an option.
Regarding helmets. Sir Hugh Cairns proposed crash helmets for motorcyclists. (The blackout led to a high number of motorcycle despatch rider fatalities in the Second World War. This was his response.) This protected the wearer in three ways : 1. Protection from direct trauma. 2. Reduction of deceleration injuries as the smooth surface would tend to slide along the ground rather than stop abruptly as an unprotected head would. 3. The round shape would tend to allow the helmet to maintain the same angle to the ground after impact rather than cause rotational/shear injury by turning the head to one of its flat sides. So probably a helmet would not have made much difference here unless it was sufficiently padded inside to reduce the deceleration. (IIRC, helmets are designed to crumple like the crash zones of a car to absorb the impact. This could make a difference.)
Aneurysm or stroke? Unlikely. A stroke would cause a fall either by causing hemiparesis (weakness of one side) or dizziness/vertigo. These would not disappear. An aneurysmal bleed sufficient to cause as fall and death within a couple of days would announce itself by a severe splitting headache; a “bursting headache”; “the worst headache of my life.” This does not appear to be the case here.
A terrible accident, and a terrible tragedy. But unfortunately not unknown.
Karl Gauss, you are right about the lucid interval in epidural haematomas. However lucid intervals are not exclusive to epidurals, but may occur in other types of trauma such as multiple contusions which coalesce and develop brain swelling.
While rapidly fatal in some instances, this is not universal. The brain itself acts as a partial tamponade and there is usually time for surgical intervention. In fact even if uncal herniation has occurred and there is lack of pupillary reaction, the patient may still be saved by sufficiently quick surgical evacuation. The great thing in these cases is that the primary pathology is the expanding haematoma, with the brain relatively spared, so there is always a chance of recovery.
I don’t know the exact time frame here, but if surgery was possible I am sure Ms Richardsom could have obtained it in Montreal, home of the Montreal Neurological Institute and the great Wilder Penfield. That this did not occur led me to postulate that brain oedema was a a major contributing factor.
It is unlikely, and better so, that the details will be released, so all we can do is speculate. And hope that we can prevent such tragedies in future.
To me, the statement: “It was a normal fall; she didn’t hit anyone or anything,” just means that she didn’t collide with a person or tree or something. Her head still could have hit the ground. People fall all the time while skiing…sometimes you just lose your balance or your skis get crossed. To me, a fall serious enough that you’re going to call it a day is probably one worth getting checked out medically.
Reports confirm that it was epidural hematoma.