The normal rule in head injuries is that if the victim did not lose consciousness at the time of the accident there should be nothing to worry about. But sometimes normal rules don’t apply. Four years ago, the death of actress Natasha Richardson after a skiing injury was described as a desperately unlucky exception. The daughter of Vanessa Redgrave, who was married to actor Liam Neeson, had got up after her fall in Quebec, Canada, in March 2009, said she felt fine and returned to her hotel. But an hour later she complained of a headache and was rushed to hospital.
Now the incident involving Michael Schumacher has proved what emergency doctors have warned: though minor blows to the head are mostly harmless, they can be lethal.
There is a condition doctors gruesomely describe as the “walk and die” syndrome, where an injury at first appears to have had little impact on a person, but causes bleeding and brain swelling in the skull with sometimes fatal consequences.
It is likely that Schumacher suffered a subdural haematoma as a result of his fall, a bleed in the brain caused by the severing of a blood vessel. The brain is like a blancmange and when it is shaken in the wooden box of the skull the vessels that supply it with blood are vulnerable to rupture. Schumacher’s helmet will have offered some protection – he would certainly be dead if he had been without it, his doctors said – but it is clear it was not enough.
Sometimes the bleeding starts slowly, leading to a gradual build up of pressure, which appears to be what happened in Richardson’s case and now in Schumacher’s. Emergency treatment normally involves drilling a hole through the skull to drain the blood or creating a window by removing a piece of bone to allow room for swollen tissues, which would otherwise be crushed and destroyed by the pressure.
Schumacher’s doctors said he had been placed in a medically induced coma – one deliberately brought about using drugs – which will reduce the brain’s need for oxygen. This is important as any damaged blood vessels will be unable to deliver the usual amount of oxygen and nutrients.
He is also likely to have been treated with diuretics, which reduce the amount of fluid in tissues increasing the production of urine, to reduce pressure inside the brain. He may in addition have received anti-seizure drugs, as victims of head injury are more likely to suffer seizures in the first week following the injury, which could further damage the brain. The outcome is as unpredictable as the accident that caused the injury. His doctors, his family and the world can only watch and hope.