What Exactly Happened to Natasha Richardson's Head?

Doctors explain the "talk and die" syndrome, which may or may not be how a ski accident turned so serious for the actress

Very upset to hear about Natasha Richardson. How can someone suffer a seemingly small accident and end up near death's door?
—Nicole, Boston

Unfortunately, this kind of tragedy is not so unheard-of among brain doctors. Some of them even refer to a brain-related injury they call "talk and die syndrome," in which a person walks away from, say, a car accident—or, in Natasha Richardson's case, a ski tumble—only to fall violently ill an hour or several hours later.

What is happening in the brain that can explain this? Well ...

We don't know enough details yet to say exactly what happened to Richardson, who remains in critical condition in a New York hospital after a Monday ski accident. But most likely, doctors say, she suffered either from brain swelling or bleeding, or both. Both of those problems can take hours to build up and produce symptoms.

"The bleeding gets worse and worse and worse until it causes pressure—same thing with swelling," New York-based neurologist Robert Melillo tells me. "Like a sprained ankle, you may not feel it right away but you wake up the next morning and you can't move."

With boxers taking hard blows to the head, for example, this phenomenon is very well known, Melillo says. 

"It could be hours or it could be minutes before a person goes into a coma," Melillo says. 

Once a patient is in a coma, if the problem is bleeding, "you have a pretty good chance of survival," Melillo says. But if the problem is swelling, "there are a lot of other factors there, the age and health of the person."

Brain and skull surgeon Hrayr Shahinian tells me that by now, Richardson has probably been scanned with an MRI or CAT scan and, if she is suffering from bleeding, doctors are attempting to drain it. If she has swelling, she probably is being given drugs to shrink the brain.

Until we hear more from Richardson's representatives, we won't know exactly what injuries she suffered, and if she indeed has this cringe-worthy "talk and die syndrome." But let's hope her condition improves very soon.

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