Full house star and stand-up comedian Bob Saget died unexpectedly last month at age 65 in a hotel in Florida, while he was traveling for a comedy tour. The cause of death was accidental blunt trauma to the head.
Saget “hit the back of his head on something, thought nothing of it and went to sleep,” according to a statement from his family. An autopsy report that the Orange County Medical Examiner’s Office sent to BuzzFeed News said he had fractures at the base of his skull and near his eye that were likely the result of a fall.
Drugs and alcohol were not factors in Saget’s death, the report said, but clonazepam — a medication used to treat seizures, panic attacks, and anxiety — as well as the antidepressant trazodone were found in his system.
Saget also was positive for COVID, according to the report.
His death is a reminder that potentially life-threatening brain injuries can happen to anyone and they are not always easy to spot, Dr. Gregory Zipfel, head of the department of neurosurgery at the Washington University School of Medicine in Missouri, told BuzzFeed News.
“This is a time to pause and think about how big a problem head trauma is, both severe head traumas like this and also milder forms that have cumulative effects over time, and the toll that takes on our communities,” Zipfel said.
Traumatic brain injuries killed nearly 61,000 people in the US in 2019 alone, according to the CDC — that’s about 166 people a day. There were more than 223,000 TBI-related hospitalizations in 2018.
Why are head injuries so dangerous?
Head injuries are dangerous because they are often unpredictable and invisible to the naked eye.
Let’s say you slip in your bathtub and hit your head. You’ll definitely feel some pain and see a bruise or bump appear. But while your brain has neurons that sense and feel pain to your skin and surrounding tissues, you can’t feel any injury to the brain itself, Zipfel said. So even a serious injury may not feel dramatic; you could still be conscious and able of conversing with others, he said.
Over time, however, things can change. As 30 minutes to an hour passes, internal bleeding can occur, which can build pressure “in such a way that you don’t have a lot of pain associated with it,” Zipfel said.
Because the brain is trapped inside the confines of the bony skull, it has nowhere to expand when it swells.
“When you injure your brain, it’s not like when you injure your ankle and you see it’s swollen and hurts,” Dr. Beth McQuiston, a neurologist who conducts research for the global health technology company Abbott in Chicago, told BuzzFeed News. “You can’t see it. So it becomes an invisible injury lurking beneath the surface that can be extremely dangerous.”
All it takes is a minor blow to a very specific part of the brain to cause serious damage, Zipfel said. For example, hits to the temple region are particularly dangerous because that’s where the thinnest part of the skull lies. It’s also right where an important blood vessel, your middle meningeal artery, sits. So even low-impact injuries like falls can fracture the skull, tear the artery, and cause a brain bleed, he said.
Not to mention, symptoms may look the same following mild or severe traumas, both Zipfel and McQuiston said.
What symptoms to look for and what to do
Generally, there are three main types of traumatic brain injuries: mild (concussions), moderate, and severe.
Concussions are typically caused by bumps to the head or hits to the body that make your brain suddenly bounce or twist in your skull, which can damage brain cells. They’re usually not life-threatening and can resolve at home — after you’ve been diagnosed.
Zipfel said it’s better to take caution and get a diagnosis than letting a potentially dangerous injury worsen under the radar.
Some serious symptoms to look out for include:
- Enlarged pupils, especially if it’s just one
- A headache that gradually gets worse or doesn’t go away
- Slurred speech, weakness, numbness, or lack of coordination
- Vomiting, convulsions, or seizures
- brief loss of consciousness
- Unusual behavior, such as confusion, agitation, or restlessness
Otherwise, be wary of sensitivity to light, blurred vision, ringing in the ears, and change in sleep patterns after a head injury.
Besides being aware of these common symptoms after head trauma, it’s always a good idea to observe anyone who injured their head for at least a couple of hours, Zipfel said.
“People can initially look good, but something severe or something serious may be happening inside their skull in the brain that within hours is going to become apparent,” he said. “And if there’s nobody around, things can go bad fairly quickly.”
Zipfel added, “If no one is around to see that this person is changing and getting sleepier, then the bleeding can continue until they go into a coma and die.”
It’s generally safe to go to sleep after a mild concussion or relatively minor head injury, but “it is often prudent” to wake someone up every couple of hours to make sure they are not developing any neurological symptoms, Zipfel said. This is especially important in the first few hours after an injury.
However, you should get any symptoms checked by a doctor before going to sleep, especially if you live alone. Zipfel said you can call your primary care doctor first or go straight to an emergency department depending on how you feel.
He recommends calling 911 after a head injury that occurs in a high-speed accident such as falling off a ladder or experiencing a motorcycle or car crash. It’s also an emergency if a person loses consciousness or has a seizure right after an injury, or if they develop neurological symptoms such as confusion, lethargy, weakness, numbness, or vision and speech problems, Zipfel said.
Even minor injuries can manifest symptoms weeks later (though the more serious the trauma, the more likely you’ll experience severe symptoms that clearly warrant a trip to the hospital).
Zipfel said neurologists are often able to treat these delayed consequences from mild brain injuries and prevent further damage.
However, since you may not be able to tell the difference between a minor or major head injury, it’s best to seek help.
Some people are at higher risk than others
Older adults, particularly those over 75, are at greater risk from seemingly minor head injuries; they have the highest rates of TBI-related hospitalizations and deaths, the CDC says.
That’s because they are more prone to slips and falls and have smaller brains than younger adults, meaning there’s more room for the brain and its blood vessels to move around and get injured in the skull.
Another reason why older adults are more likely to experience head trauma is that they are more likely to be taking blood thinners, such as warfarin (sold as Coumadin), aspirin, clopidogrel (Plavix), and rivaroxaban (Xarelto). These medications can increase the risk for bleeding in the brain following any trauma, which means you could have a pretty mild head injury, but have a very severe bleed if you are taking blood thinners, Zipfel said.
Some groups of people, including older adults, military members and veterans, survivors of domestic violence, people of color, people experiencing homelessness, and those in correctional facilities, are more likely to die from and have long-term consequences after traumatic brain injuries, the CDC says.
The reasons revolve around poor access to healthcare, a history of substance abuse, and higher rates of car crashes and other injuries.
Men are also about two times more likely to require hospitalization than women, and three times more likely to die from traumatic brain injuries.
While sports are well known for their high injury risks, simple slips and falls account for nearly half of brain injury–related hospitalizations. Because crashes, assaults, and firearm-related suicide are other common causes of head trauma.
While some accidents are unavoidable, there are steps you can take to reduce the risk of a traumatic brain injury. “Prevention is key,” McQuiston said. Make sure you wear helmets when appropriate and necessary, and use handrails on stairs, especially when outdoors in the winter.
“The best injury is the one you don’t have,” she said.