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The tragic news that comedian and former Full House star Bob Saget died last month after hitting his head then falling asleep has raised myriad questions about the health consequences of seemingly ordinary falls.
A medical examiner ruled that Saget, who was on tour and alone in a hotel room, died from blunt head trauma.
To get a better understanding of traumatic brain injuries, we asked Nicole D. Reams, MD, NorthShore Neurological Institute, to weigh in on Saget’s traumatic injury and explain symptoms that might signal a severe injury:
In the type of injury, Bob Saget reportedly had, what happened to his brain that would cause death?
Dr. Reams: It’s likely that Mr. Saget suffered intracranial bleeding, probably a subdural hematoma. This means that there is an area of bleeding that occurs between the skull and the lining of the brain, so it’s outside brain tissue but within the skull. When bleeding accumulates between those two intracranial compartments, there is no space for the brain to go, so it gets compressed and herniates or moves downward. When this happens, very vital structures can be affected, such as the brain stem, which controls our primitive functions, such as breathing and heart rate, and results in the cause of death.
How common is it for someone to hit their head hard enough to have a brain bleed but not have noticeable or serious enough symptoms that they would call 911 or head to the Emergency Department?
Dr. Reams: I don’t know what kind of impact Mr. Saget took but it’s possible he didn’t think it was that intense and brushed it off and went to sleep. Or maybe he had onset of typical concussion symptoms like headaches, dizziness, and nausea and felt he’d sleep it off and feel better in the morning. The most dangerous window for complications like bleeding is in the first few hours, so monitoring after a big impact can be important. Rarely, bleeding in the brain can happen after a delay of days to weeks. Over the course of 7 years, I have seen it about four times.
How quickly can this happen if someone initially doesn’t have symptoms? What should people watch for?
Dr. Reams: Red flag symptoms can happen within an hour or two of injury or may take days to develop. I tell my patients to watch out for the course of the symptoms changing.
For example, if someone had a typical concussion and was improving steadily over time, then it takes a turn for the worse. Maybe they initially had headaches, dizziness or nausea, but then it starts to get much worse. The headaches are more severe, they are repeatedly vomiting, or they experience a new symptom, such as numbness on one side of their body. If this happens, they should go to the ER immediately for evaluation.
What should people do if they have a head injury without noticeable symptoms late at night and want to go to sleep?
Dr. Reams: My suggestion is that we do have a monitoring period of at least an hour long. Keep that person awake for an hour or so to watch for changing or worsening symptoms. If symptoms are stable, we want to encourage sleep: research has found that sleep is extremely important for the repair of the brain in early injury. There is no need to wake someone up every hour if you have had sufficient time to monitor them prior to sleep. Refrain from taking any sleep aids, alcohol, or anything that may make them more sedated and less able to respond should symptoms worsen.
What puts people at higher risk for suffering a serious injury like Bob Saget?
Dr. Reams: As we get older, our brains get a little bit smaller, and that’s normal for aging. The veins that bridge between the brain and skull, called bridging veins, have a little bit more tension on them, which means when an older person falls or takes an impact, those veins are more likely to tear or break. It may take less of an impact to break those veins, increasing the possibility of a head injury being complicated by bleeding. Individuals on blood thinners are at higher risk as well.
We may have some additional protection if we can be around another person and even alert friends or family to call to check on us every couple of hours in the aftermath of a head injury, to have another set of eyes/ears should symptoms worsen.
The important thing to remember is that if you have symptoms after hitting your head and you don’t know if it is serious or not, call your doctor or go to the Emergency Department for a CT scan.
For more information, contact the NorthShore Concussion Clinic.