Last updated: Mar 18, 2009
Our thoughts and prayers this week are with the family of Natasha Richardson, after the actress suffered a fatal brain injury while skiing in Canada. But its also left many of us wondering exactly how Richardson was hurt so badly—and whether its something that could happen to us.


Whats scary about Richardsons injury is that she didnt hit a tree or attempt any risky tricks; reports say she simply fell down and hit her head (without wearing a helmet) at the bottom of a beginners slope. Thats happened to me plenty of times while skiing, not to mention while biking, playing soccer, and yes, even once while tripping over a curb during a run.

If reports are correct, Richardson said she felt fine, was joking and laughing shortly after her fall, and insisted on walking back to her room instead of seeking medical care. And hours later, she was fighting for her life.

If traumatic brain injuries can occur so easily—and be so hard to identify—what precautions should we take while skiing, biking, or playing sports? And if we do get hurt, how do we know whether were in serious danger?

I called Stephan Mayer, MD, a neurologist who works in the neuro-intensive care unit at New York-Presbyterian Hospital in New York City, for a quick sports-safety run-down. Heres his advice.

Check for signs of a concussion
Any time a person is hit in the head, someone at the scene should perform a quick “mental status exam” to make sure he or she is not suffering from confusion or memory loss, signs of a potentially life-threatening concussion or internal bleeding (which was likely the cause of Richardson's brain damage). This includes asking simple math and knowledge questions, making sure the injured person can follow your finger with his or her eyes, and asking if he or she can tell you what happened in the last few minutes. “On the sideline of a sporting event, a trainer will do this,” says Dr. Mayer, “but in reality, you really dont need any special training to do this. A lot of it is common sense.”

You dont have to pass out to have a serious injury
“The language we use is ‘altered consciousness,” says Dr. Mayer. “It's a whole spectrum: You could be out cold, or, recently were diagnosing a lot of concussions in which the person remains standing, with eyes open, with just kind of a glazed look.”

Take confusion or sleepiness seriously

Its not so much pain that should be a warning sign of serious injury; anyone who gets a hard wallop to the head is likely to develop a monster of a headache, whether theres internal damage or not. But any type of confusion, dizziness, memory loss, nausea, or sleepiness—anything to signal that the brain is malfunctioning—should not be taken lightly. Call 911, and get to a hospital right away.

Err on the side of caution
“Its better to waste an afternoon in the E.R. just to make sure everything is okay than to brush it off and underestimate how bad an injury might be,” says Dr. Mayer. “The key thing we know about traumatic brain injuries is that our ability to help is tremendous within the first hour. Then, its a little less in the second hour, less than that in the third, and so forth. Time equals brain, we say.”

Wear a helmet
Anytime helmets are optional (as in biking, skiing, or any other sport that involves high-speed or high-altitude movement), wear one. “When I was a kid, seat belts werent mandatory in cars; neither were helmets for motorcycle riders,” Dr. Mayer says. “Helmets arent required for skiing now, but that may change. Ill be honest with you, I ski, and I dont usually wear a helmet. But Im going to change after this.”

While traumatic brain injury is one of the leading causes of death and disability among children and young adults—and while there is a type of brain injury in which the patient feels fine and then rapidly deteriorates—Dr. Mayer admits that the details of Richardsons tragic death are still surprising.

“The majority of people who walk into a hospital on their own after a head injury are going to be just fine,” he adds. “The important thing is to take precautions, recognize the signs of serious danger, and get help as soon as possible.”