Vol. 2, Ep. 9 "Hematoma'" (2009)


Apologies to Liam Neeson (Vol 2, Episode 9)

 A head injury where a person feels OK for a while followed by deterioration is classic. Contrary to what the initial news reports stated about the Natasha Richardson incident, her fall was actually quite serious, resulting in a skull fracture. This caused internal vascular damage, culminating in the formation of the epidural hematoma and her death.

 An epidural hematoma, which causes bleeding between the skull and the brain's covering, 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.

 Symptoms of an intracranial hematoma include the following:

  • Headache
  • Nausea/vomiting
  • Seizures
  • Isolated nerve problems, usually in the face, such as abnormal visual fields, numbness or weakness

 A physical examination may show some of the following signs:

  • Slow heart rate and/or hypertension indicative of increased intracranial pressure
  • Skull fractures, superficial hematomas or lacerations
  • A clear fluid coming from the ear or nose, resulting from a skull fracture with a tear of the dura
  • Alterations in the level of consciousness
  • Dilation of one pupil due to compression of the ocular nerves
  • Facial muscle weakness
  • More generalized body muscular weakness

 Some things people can do to prevent hematomas include not running headfirst into walls, wearing a helmet when riding a motorcycle and organizing a worldwide boycott of supercilious winter sports… like skiing.