'Don't write it off': Advice from brain injury experts after Bob Saget's death

WASHINGTON (NYTIMES) - It appeared to be an ordinary fall: Bob Saget, the actor and comedian, knocked his head on something and, perhaps thinking nothing of it, went to sleep, his family said on Wednesday (Feb 9).

But the chilling consequences - Saget, 65, died some hours later on Jan 9 from blunt head trauma, a medical examiner ruled - have underscored the dangers of traumatic brain injuries, even those that do not initially seem to be causes for alarm.

Some 61,000 deaths in 2019 in the United States were related to traumatic brain injuries, according to the Centres for Disease Control and Prevention, and nearly half of head trauma-related hospitalisations result from falls.

Brain injury experts said that Saget's case was relatively uncommon: People with serious head trauma would be expected to have noticeable symptoms, like a headache, nausea or confusion. And they can generally be saved by surgeons opening up their skull and relieving pressure on the brain from bleeding.

But certain situations put people at higher risk for the sort of deterioration that Saget experienced, doctors said.

As serious a risk factor as any, doctors said, is simply being alone. Someone with a head injury can lose touch with their usual decision-making capacities and become confused, agitated or unusually sleepy. Those symptoms, in turn, can stand in the way of getting help.

The US Centres for Disease Control and Prevention (CDC) warns that traumatic brain injuries can be overlooked in older people when the symptoms overlap with those seen in other common ailments, such as dementia.

People aged 75 and older account for roughly one-third of head trauma-related hospitalisations, the agency said, although experts said they tend to apply extra caution to any patients who are at least 60 years old. CDC data indicates that men are at higher risk than women.

And, while there was no indication that Saget was taking blood thinners, experts said the medications can greatly accelerate the type of bleeding after a head injury that forces the brain downward and compresses the centres that regulate breathing and other vital functions. More Americans are being prescribed these drugs as the population ages.

Saget had been in an Orlando, Florida, hotel room during a weekend of stand-up comedy acts when he was found unresponsive. The local medical examiner's office announced on Wednesday that his death resulted from "blunt head trauma" and said that "his injuries were most likely incurred from an unwitnessed fall". There was no evidence of illegal drugs in his system, the medical examiner said.

"If you have a head injury, you never - and I mean never - be by yourself for the first 24 hours," said Dr Gavin Britz, the chairman in neurosurgery at Houston Methodist Hospital.

Dr Britz said he would advise people who get a significant knock to the head to see a doctor or, short of that, to ask someone to track their symptoms and even wake them up occasionally at night for monitoring.

Brain injury experts also emphasised that the presence of symptoms usually indicated whether medical help was needed.

"There's no need to call the doctor after a little bump," said Dr Jeffrey Bazarian, an emergency physician and concussion expert at the University of Rochester Medical Centre. On the other hand, "if you hit your head and have lingering sypmtoms, like a headache or confusion, that requires medical attention - especially if you're on a blood thinner", he said.

Neither Saget's family nor the medical examiner offered details on Wednesday about precisely how the head injury had killed him.

The family specified that Saget had accidentally hit the back of his head.

The back and sides of the skull tend to be less strong than the front, making it more likely that knocks in those regions result in bleeding, said Dr Angela Lumba-Brown, an associate professor of neurosurgery and paediatrics at Stanford University School of Medicine.

Still, she said, significant blows to any part of the head can cause problems.

Doctors said there were a number of possible scenarios for how Saget died. They also cautioned that crucial details of his case were missing, like whether he had underlying conditions and the precise nature of his injuries.

Brain experts said that as Americans age and, in many cases, go on blood thinners after a heart attack or stroke, the risks of head injuries became more pronounced.

"As our population is ageing, we have to be aware of the risks that come with being on blood thinners," said Dr Neha Dangayach, director of neuroemergencies management for Mount Sinai Health System. "If you fall or hit your head, don't write it off."

Still, doctors said, those head injuries were often easily treatable and deaths usually completely preventable.

Dr Jamshid Ghajar, a neurosurgeon at Stanford University School of Medicine who has worked on guidelines for treating brain injuries, said he had operated on a 100-year-old with a serious head injury.

"I took the blood out, and he was awake right away after," said Dr Ghajar.