The death of popular comedian Bob Saget while on tour in Florida last month was surprising and tragic, but the injury that took his life is more common than you might think.
According to the Florida medical examiner who performed the autopsy, Saget is most likely fell and hit the back of his head, causing a cerebral hemorrhage. Saget’s family said he probably thought nothing of the injury and fell asleep. A hotel employee found him dead in his bed the following afternoon.
On a typical day, brain injuries like Saget’s claim the lives of more than 160 people in the United States, according to the Centers for Disease Control and Prevention. About 61,000 people died from traumatic brain injury, or TBI, in the United States in 2019 alone.
Certainly, the most common cause of death from TBI is gun-related suicide. Car accidents and assaults are other common sources of these injuries. But nearly half of hospitalizations for TBI come from the simple act of falling, according to the CDC.
Saget was 65, which puts him in an age group particularly susceptible to damaging falls. A 2006 study published by the Journal of the American Geriatrics Society found that “among people age 65 and older, TBI is responsible for more than 80,000 emergency room visits each year; three-quarters of these visits result in hospitalization as a result of the injury. More than half of these injuries result from falls.
According to the CDC, “data suggest that some groups are more at risk of dying from a TBI or having long-term health problems after the injury. These groups include racial and ethnic minorities, members and veterans of the armed forces, homeless people and rural dwellers.
Everyone comes up against something at some point in their life. So how do you know if there is cause for alarm? Here are some tips from three brain injury experts: Dr. Christopher C. GizaUCLA Steve Tisch BrainSport program director; Dr. May Kim-Tensera neurologist with USC Keck Medicine; and Dr Joshua Marcusneurosurgeon at Nuvance Health in Connecticut.
What causes traumatic brain injury?
Thousands of Americans suffer traumatic brain injuries each year, but incidents like those that claimed Saget’s life are rare. And while head injuries are “super common,” Marcus said, “the overwhelming minority leads to something serious.”
Hitting the headboard while you’re in bed shouldn’t land you in the hospital. “It must be a pretty traumatic fall,” Kim-Tenser said. “It really has to be a pretty hard blow to the head,” involving a hard impact on a hard surface.
Giza agreed. “Bumping your head against the headboard isn’t going to create much force,” he said. By contrast, he said, “sliding into the bathroom and banging your head against the edge of the tub is going to have considerable force.”
The brain can also be harmed in a less direct way, when a violent event – a car accident, for example – pushes it against the skull. A shear injury it’s when “the brain goes one way, the force goes the other way,” Marcus said. Then there is backlash injurieswhen a force on one side of the head sends the brain into the skull on the other side.
Damage is caused when a blood vessel inside the skull ruptures, causing blood to pool between the brain and its surroundings. “The skull is a closed box, for the most part,” Gizeh said, “so if you start filling part of that space with bleeding, the rest gets crushed.”
Once you start squeezing the brain, it doesn’t work very well. People can go into a coma or become paralyzed. And if pressure is applied to the brainstem (the part near the spinal cord), it can interfere with a person’s breathing and heartbeat, Giza said. Beyond that, he said, the pooled blood irritates the surface of the brain, potentially triggering seizures.
Giza and Marcus said certain parts of the head are worse than others when it comes to brain damage. Because the compartment around the brainstem is relatively small, Gizeh said, it takes less blood to cause problems there. And the fracture to the temporal bone above the ear could sever an artery, causing blood to flow rapidly through the brain, Marcus said.
Red Flag Symptoms
Experts say the telltale signs of a serious brain injury tend to be changes in behavior and mental functions. A seizure, paralysis, significant confusion, loss of coordination and vomiting are red flags that should send you straight to the emergency room, Giza said.
Kim-Tenser also pointed to feeling disoriented and drifting in and out of lucidity as indications of a real problem. Marcus added numbness and tingling to the list, as well as feeling lethargic or drowsy. “Being tired after a head injury is a bad sign,” Marcus said.
That’s not necessarily a reason to keep someone who’s been struck in the head awake all night, Gizeh said. But monitoring that person is extremely important, he said, because it’s a sign of a serious problem if neurological or behavioral symptoms worsen over time.
For example, mild headaches are common after a traumatic brain injury, so they are not red flags in themselves. But if they get worse instead of going away after a few days, that’s a reason to see your doctor.
Marcus noted that sometimes injuries cause delayed bleeding, so crucial symptoms can take a few days to appear. This is especially true with older patients, he says.
“It’s not very common for someone to hit their head and then have a severe brain bleed and not notice it,” Giza said. “But another risk that can amplify things is if someone is completely alone. Being completely alone is extremely problematic if your symptoms start to get worse. If you start to get confused or have memory problems and you are alone, he said, you may not recognize the situation you are in.
As with so many things in medicine, personal factors can play a large role in determining whether a head injury results in a serious injury. According to the Cleveland Clinic, you are more susceptible to brain hemorrhages if you are older because the blood vessels around your brain are more likely to tear; if you have hemophilia or are taking blood thinners; if you practice contact sports; if you abuse alcohol, because “damaged livers cannot produce enough protein that helps blood clot”; or if you are a baby, because weak neck muscles make you more susceptible to head injuries.
Other things to watch out for
Even if there are no warning symptoms, a head injury may be serious enough to warrant calling your doctor and being monitored for a few days.
Being sensitive to light or noise, feeling nauseous and having blurry or double vision are all signs that deserve closer attention, Gizeh said. If you lost consciousness when the injury happened, Marcus said, “that’s a concerning symptom related to the fall itself.”
A bump on the head might look really bad, Gizeh said, but that doesn’t necessarily mean there’s an underlying brain injury. The swelling may be confined outside the skull. However, the more swelling there is, the harder it will be for a doctor to feel for a skull fracture, he said.
A lot of bleeding is also not necessarily a sign of brain damage. “A scalp cut can bleed quite impressively,” Giza said, noting that almost 20% of the heart’s output is pumped to the head (mainly for the brain).