Lessons from Bob Saget’s tragic death
The sudden death of actor and comedian Bob Saget took fans and friends by surprise. At the age of 65, Saget was found dead in his Florida hotel room recently after performing live while on a comedy tour. When the autopsy report was made public a month later, it revealed that Saget died from blunt head trauma. The report stated that Saget had fractures to the back of his head and around his eyes, leading some people to wonder how it could be possible to do so much damage to your skull simply from a fall in a hotel room.
But neurologist Karen Lynch, MD, of Neurologists of Cape Cod in Hyannis, said it is very possible to sustain that degree of injury from a fall like Saget likely took, especially if the person has other factors such as prescription drugs or alcohol in their system.
Dr. Lynch’s experience when she worked in Ireland included forensic pathology where she went out to crime scenes as the physician (common practice in UK and Ireland) and saw a lot of unusual deaths and circumstances. She also spent a year working in neuropathology performing brain dissections on people who died from brain trauma from a variety of reasons.
“I have seen all of these different severe, fatal head injuries that happened without violence or any suspicious activity,” she said. “There were circumstances that potentially may not have led Saget to make the right decision and may have caused worsening of the severity of his ultimately fatal head injury. He may have overmedicated and/or not been completely aware of what was going on. It does highlight some of the challenges we see with severe head injuries like this that unfortunately can lead to severe disability and death if people aren’t aware.”
Saget’s family released a statement that his autopsy revealed the actor did not have any alcohol or illegal drugs in his system, but the autopsy did show that he was taking the drug clonazepam, which is prescribed for anxiety, and trazodone, which is often prescribed for depression or sleep disorders. Those drugs could be enough to have altered Saget’s judgement and caused more confusion and overly sedated him along with the symptoms of his traumatic head injury. Dr. Lynch said, “A serious head injury like he had also could have knocked him unconscious, leaving him unable to call for help.”
A Common Cause of Disability and Death
Saget is the latest celebrity to die from a traumatic brain injury, but they are far from rare in the general public. The CDC reported that 166 people a day died from a traumatic brain injury in 2019 and 223,000 people were hospitalized for it the year before.
While most head injuries aren’t serious, it’s important to know when to seek medical attention, Dr. Lynch said. If someone has a mild head injury, the most common symptoms are headache, sensitivity to noise, irritability, ringing in the ears, fatigue and trouble with memory and concentration. These symptoms can last for weeks.
The treatment for these types of injuries is observation, over-the-counter medications to treat headaches, rest (but not alone), reducing screen time and taking time off from work and school.
Even though milder head injuries are usually not serious, there are some that can cause problems. Dr. Lynch had a patient who opened the trunk of her car and banged the back of her head. Over the course of a few days, she developed a subdural hematoma that required neurosurgical draining. So, what may seem like a fairly innocuous hit to the head can manifest into more over ensuing days.
That makes it important for family members to pay close attention and be aware of any change in behavior, mental status, head pain or pupil dilation for example. Doctors usually recommend a family member or friend stay with the person for at least 12 hours. They also recommend waking the person up every few hours to make sure they are still okay. One of the most important risk factors in the Saget tragedy is that he was all alone.
When to Seek Care
Anyone with any kind of drugs or alcohol in their system should seek medical attention, Dr. Lynch said. Other signs of danger include losing consciousness or having a bad headache that won’t go away. People who take blood thinners also face more significant danger (This was the case with Saget).
“Anyone who is on a blood thinner should seek medical care because the chance of them having a bleed, if it is a significant head injury, is much higher,” she said. “Even a milder head injury can be enough to cause a significant hemorrhage that they may not be aware of for hours. It doesn’t happen right away. These bleeds could build up, so people could go to bed and die in their sleep.”
If in doubt, people need to go to the Emergency Room for a good medical evaluation and possibly some testing like a CAT scan or X-rays, Dr. Lynch said. Sometimes the ER doctor will do a blood test if the patient is on a blood thinner just to see how thin the blood is and if it needs to be reversed.
If the patient does have a brain hemorrhage, they would be admitted to the hospital. Some cases may require neurosurgery input. Because adult skulls can’t expand the way young children’s can, the expanding blood and brain swelling are dangerous. In those cases, a neurosurgeon would make a burr hole to drain the blood and release the pressure or remove part of the scalp to allow the brain to swell appropriately. The piece of skull is replaced after the swelling goes down. These patients are often put in the intensive care unit and may have to be put on a ventilator.
“With neurology we continue to monitor their neurological status to determine if there is going to be any long-term or potentially significant brain injury as a result,” Dr. Lynch said. “A lot of the time the patients can improve if it is caught early. The vast majority of them do. But those who have significant bruising or damage on the brain tissue may have neurological symptoms like weakness, loss of fine motor skills, speech difficulty, vision changes, cognitive problems and sometimes behavioral and personality disorders.”
Because head injuries can potentially be so dangerous, prevention is key, Dr. Lynch said. Wear a seat belt while in the car. Wear a helmet when doing risky activities like skiing, snowboarding, bike riding or skateboarding. Avoid using mind-altering drugs and excessive alcohol. Older people are at a higher risk of falling, should use a cane or other walking aid.
The older population would also benefit from having an occupational therapist from the Visiting Nurse Association of Cape Cod visit their home for a home assessment on falling risks. They can make recommendations like removing all throw rugs, installing guardrails or a shower chair and ensuring the home has proper lighting. A medical device that detects falls is also a good idea for those at risk.
“It’s important to promote a safe environment where people don’t get head injuries in the first place,” she said. “Overall, I think vigilance is the key. Just be mindful that if a head injury does happen, it can go in a bad direction.”