How can it be possible for a healthy 45 year-old woman to take a spill on a "bunny hill" and end up brain dead within the day?
That's the question that I posed to neurologist Dr. Dexter Sun, who practices at New York Presbyterian Hospital/Cornell in New York City. First of all, rest assured he said: this is a highly unusual case. Normally, a tragedy like this occurs only after a very heavy impact accident, says Dr. Sun.
With that said, Dr. Sun explained that there are three particular possibilities that could account for Natasha Richardson's state:
1. "She may have a fairly rare underlying hematology condition called hypocoagulation, in which she lacks a blood clotting factor," says Dr.Sun. This could be a genetic factor which had gone unnoticed throughout her life until now. When the clotting factor is missing, a minor bleed can become a hemorrhage.
2. It's possible that Natasha could have been taking a blood thinner like coumadine, for another medical condition, that would have made it much more likely for her to bleed after any head injury, according to Dr. Sun.
3. Finally, and most likely, she did have a harder spill than what has been reported. Sometimes when this happens "you can have a high level cervical spine fracture or a fracture at the base of the skull," says Dr.Sun. When this occurs, and the injured person continues to move around as Natasha did -- not realizing that she was seriously hurt -- the spine can touch the brain stem and cause a severe brain injury.
A high impact fall on the head can also cause three different types of bleeding within the brain: 1) an intracranial hemorrhage, which begins as a microscopic rupture of a blood vessel deep within the brain, 2) a subdural hematoma, which is a bleed that occurs in the dura, which is the outer layer of the brain, or 3) an epidural hematoma, which is a hemorrhage, that takes place between the outer skull and the dura.*
As for why Natasha initially seemed perfectly fine after her spill, apparently the hemorrhage can begin in one small spot in the brain and then grow in intensity.
All of these types of bleeding and the cervical spine fracture, result in dramatic swelling of the brain and pressure in the skull, which also pushes down dangerously on the brain stem, which is the center of life, according to Dr. Sun.
Big question: Was there ever a chance to save Natasha Richardson's life? If she hadn't insisted that she was fine and walked back to her room, could prompt medical treatment have made a difference?
Since initially there was no indication that Natasha's life was in danger, it's unlikely that she could have been saved. She would have needed to be rushed into the hospital and into a CT scan in a matter of minutes, according to Dr. Sun.
"If she had gone to the hospital and a CT scan indicated that there was bleeding, her skull would have been opened to relieve pressure, and she would have been given medication to relieve the pressure in her brain," he says.
Only then, would there have been a chance that she could pull through.
For more on Natasha Richardson follow Bonnie Fuller at twitter.com/ bonniefuller.