It turned out to be an ordinary fall: Bob Saget, the actor and comedian, hit his head on something and, perhaps unthinkingly, fell asleep, his family said Wednesday.
But the horrifying consequences — Mr Saget, 65, died just hours later on Jan. 9 of blunt head trauma, a medical examiner ruled — have highlighted the dangers of traumatic brain injury, even those that may initially appear to be no cause for alarm.
About 61,000 deaths in 2019 were related to traumatic brain injuries, according to the Centers for Disease Control and Prevention, and nearly half of head trauma-related hospitalizations are due to falls.
Brain injury experts said on Thursday that Mr Saget’s case was relatively unusual: People with severe head trauma are expected to have noticeable symptoms, such as headaches, nausea or confusion. And they can generally be rescued by surgeons opening their skulls and relieving pressure on the brain from bleeding.
But in certain situations, people are at greater risk for the kind of deterioration Mr Saget experienced, doctors said.
A risk factor as serious as any other, doctors said, is simply being alone. A person with a head injury may lose contact with their usual decision-making abilities and become confused, agitated, or unusually sleepy. Those symptoms, in turn, can get in the way of getting help.
And while there was no evidence that Mr. Saget was taking blood thinners, experts said the drugs can significantly speed up the type of bleeding after a head injury that forces the brain down and compresses the centers that control breathing and other vital functions. As the population ages, more Americans are being prescribed these drugs.
Saget had been in an Orlando hotel room over a weekend of stand-up comedy acts when he stopped responding. The local medical examiner’s office announced on Wednesday that his death was the result of “blunt head trauma” and said “his injuries were most likely caused by a fall without anyone witnessing it.”
There was no evidence of illegal drugs in his system, the coroner said.
“If you have a head injury, you’re never — and I mean never — alone for the first 24 hours,” says Dr. Gavin Britz, the chair of neurosurgery at Houston Methodist.
dr. Britz said he would advise people who receive a major blow to the head to see a doctor or, instead, ask someone to monitor their symptoms and even wake them up occasionally at night for a checkup.
Brain injury experts also emphasized that the presence of symptoms usually indicated whether medical attention was needed.
“There’s no need to call the doctor after a minor bump,” says Dr. Jeffrey Bazarian, an emergency room physician and concussion expert at the University of Rochester Medical Center. On the other hand, he said, “If you hit your head and have persistent symptoms, such as a headache or confusion, then medical attention is required — especially if you’re on a blood thinner.”
The CDC warns that traumatic brain injuries in older people can be overlooked when symptoms overlap with those seen in other common conditions, such as dementia.
People aged 75 and older account for about a third of head trauma-related hospitalizations, the agency said, although experts said they tend to be extra cautious in patients who are at least 60 years old. CDC data indicates that men are at higher risk than women.
Neither Saget’s family nor the coroner gave details Wednesday about exactly how the head injury had killed him.
The family indicated that Mr. 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 bumps in those regions more likely to lead to bleeding, said Dr. Angela Lumba-Brown, an associate professor of neurosurgery and pediatrics 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 Mr. Saget died. They also warned that crucial details of his case were missing, such as whether or not he had underlying conditions and the precise nature of his injuries.
In one scenario, they said, more common in younger patients, for someone to receive a blow to the head severe enough that their skull fractures, rupturing a blood vessel or artery between the skull and the thick lining that covers the brain. The result is an epidural hematoma, and the bleeding can be fatal. In some such cases, there is an interval in which patients feel good.
That was the injury that killed actress Natasha Richardson in 2009 after what appeared to be a minor fall on a beginner ski slope.
“Maybe you have a little headache and you go to bed, and the blood clot expands,” said Dr. britz. “Over time, it gets so big that you get brainstem compression.”
Another scenario is a fall where tiny veins rupture between the membrane covering the brain and the brain itself, doctors said. That kind of injury is more common in older patients — in part a result of brain shrinkage as people age, doctors said, and the prevalence of blood thinners.
In those cases, known as subdural hematomas, symptoms can develop quickly or over weeks.
Brain experts said that as Americans age and, in many cases, take blood thinners after a heart attack or stroke, the risk of head injuries increases.
“As our population ages, we need to be aware of the risks associated with taking blood thinners,” says Dr. Neha Dangayach, the director of neuro-emergency 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 easy to treat and deaths were 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 surgery on a 100-year-old for a serious head injury.
“I got the blood out,” said Dr. Ghajar, “and he was awake right after that.”