Editor’s note Feb. 14, 2022: This analysis is based upon a statement by Bob Saget’s family that the comedian’s death was caused by a brain bleed that occurred after Saget hit his head and went to sleep, not realizing the extent of his injury. An autopsy report, released later, indicates that Saget’s injuries were much more severe, and included several skull fractures.
Actor and comedian Bob Saget was on stage for hours performing a standup set the night before his death last month. After the show, he posted on Twitter to celebrate the experience and promote his tour. Nothing seemed amiss from the outside. But the next morning, he was found dead in his hotel room.
Now, a medical examiner has ruled that Saget died from blunt head trauma. What likely happened is that he fell and knocked his head on something, didn’t think much of it, and went to sleep. Then, while he was unconscious, the head injury progressed to become fatal.
What’s striking about this kind of head trauma, says Gian Corrado, head team physician for Northeastern athletics and director of emergency sports medicine at Massachusetts General Hospital, is that there is a period of time after the bump that you might feel just fine, and you might not be showing any cognitive impairment. That’s called a “lucid interval” and, Corrado says, it can last for anywhere from minutes to hours before symptoms of a serious brain bleed might begin to show—and death can quickly follow.
Emergency surgery can save a patient from dying from a brain bleed, Corrado says. However, this “lucid interval” can delay that urgent care until it is too late.
“When somebody hits their head, they may have no bleeding, they may just have microscopic trauma,” Corrado says. That’s the case with concussions, and nothing shows up on a CT scan. “But if someone has head trauma, they can have one of four types of bleeds.”
The four kinds of bleeds are named for which layer in the brain the bleed occurs. Saget probably experienced an epidural hematoma, which happens when blood collects between the skull and the outermost protective membrane covering the brain, Corrado says. This kind of brain bleed is characterized by the lucid interval, which often comes after a brief moment of losing consciousness after the head is injured. An epidural hematoma is also how actress Natasha Richardson died after a ski accident.
“The problem with the head is there is no place for swelling to go in the cranium,” Corrado says. “And because there’s no place for swelling to go, as the brain quickly swells after this bleed, it will herniate down into the midbrain and cause death.”
Emergency surgery can be performed to relieve that pressure. That’s why Corrado urges anyone who experiences a serious head injury to go to the hospital right away and get a CT scan.
But, Corrado says, this probably isn’t something you need to worry about with minor bumps on the head.
“You don’t get this from banging your head on a shelf,” he says. “You really have to give yourself a pretty good wallop.”
Someone who is under the influence of drugs or alcohol might be more at risk for a brain bleed, Corrado adds. In addition to alcohol thinning the blood, if someone who has been drinking were to trip, for example, they might not react quickly and break their fall in the way they normally would, resulting in a harder hit.
Doctors advise against going to sleep after a head injury. That’s not because sleep itself is bad for someone with a head injury, Corrado says. Rather, he says, it’s because “their neurological deterioration would happen without anybody seeing in their sleep.”
If someone hits their head hard and doesn’t go to the hospital for a scan right away, Corrado says they should not be left alone or allowed to go to sleep so that someone can check in with them regularly and see if their cognitive abilities are worsening. Asking them questions such as: “What time is it?,” “Where are you?,” “How are you feeling?,” and “What’s your grandmother’s name?,” as well as asking them to do simple arithmetic, could help an observer catch a concerning turn for the worse.
“But, quite honestly, if somebody has had the kind of head injury that you think could be an epidural and could lead to a lucid interval and that rapid death,” Corrado says, “you want to go right to the hospital and get a CT scan.”