Still, the autopsy left a number of unresolved questions about how exactly Mr. Saget, 65, was so badly hurt. He was found dead in a hotel room at the Ritz-Carlton Orlando, Grande Lake on Jan. 9 during a weekend of stand-up comedy acts. His family said this week that the authorities determined that he had hit his head, “thought nothing of it and went to sleep.”
‘Don’t Write It Off’: Advice From Brain Injury Experts After Bob Saget’s Death
People who find themselves alone after a significant knock to the head are at higher risk of harm.
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Doctors said that the fall that killed Bob Saget in his hotel room last month was uncommon. Credit. Phillip Faraone/Getty Images
Feb. 10, 2022
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.
But the chilling consequences — Mr. 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 were related to traumatic brain injuries, according to the Centers for Disease Control and Prevention, and nearly half of head trauma-related hospitalizations result from falls.
Brain injury experts said on Thursday that Mr. 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 Mr. 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.
And while there was no indication that Mr. 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 centers that regulate breathing and other vital functions. More Americans are being prescribed these drugs as the population ages.
Mr. Saget had been in an Orlando 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 chair in neurosurgery at Houston Methodist.
Dr. Britz said that he would counsel 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 emphasized 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 Center. On the other hand, he said, “If you hit your head and have lingering symptoms, like a headache or confusion, that requires medical attention — especially if you’re on a blood thinner.”
The C.D.C. warns that traumatic brain injuries can be overlooked in older people when the symptoms overlap with those seen in other common ailments, like dementia.
People 75 and older account for roughly one-third of head trauma-related hospitalizations, the agency said, though experts said they tend to apply extra caution to any patients who are at least 60 years old. C.D.C. data indicate that men are at higher risk than women.
Neither Mr. Saget’s family nor the medical examiner offered details on Wednesday about precisely how the head injury had killed him.
The family specified that Mr. Saget had accidentally hit the back of his head. Injuries to the sides and back of the skull may be associated with significant brain bleeding, said Dr. Angela Lumba-Brown, an associate professor of emergency medicine at Stanford University School of Medicine.
Still, she said, significant blows to any part of the head can cause problems.
Doctors said that there were a number of possible scenarios for how Mr. Saget died. They also cautioned that crucial details of his case were missing, like whether or not he had underlying conditions and the precise nature of his injuries.
In one scenario, they said, more common among younger patients, someone receives a blow to the head serious enough that their skull fractures, rupturing a blood vessel or artery between the skull and the thick lining covering the brain. The result is an epidural hematoma, and the bleeding can be deadly. In some such cases, there is an interval when patients feel fine.
That was the injury that killed the actress Natasha Richardson in 2009 after what appeared to be a minor fall on a beginner’s ski slope.
“Maybe there’s a bit of a headache, and you go to bed, and the blood clot expands,” Dr. Britz said. “Over time, it gets so big that you get brain stem compression.”
Another scenario is a fall that ruptures small veins between the membrane covering the brain and the brain itself, doctors said. That kind of injury is more common in older patients — a result, in part, of brains shrinking as people age, doctors said, and the prevalence of blood thinners.
In those cases, known as subdural hematomas, symptoms can develop quickly or over the course of weeks.
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 become more pronounced.
“As our population is aging, we have to be aware of the risks that come with being on blood thinners,” said Dr. Neha Dangayach, the 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 that he had operated on a 100-year-old with a serious head injury.
“I took the blood out,” Dr. Ghajar said, “and he was awake right away after.”
Bob Saget’s Autopsy Report Describes Severe Skull Fractures
Such an extensive head injury would likely have left the actor confused, if not unconscious, experts said.
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Experts said that Bob Saget’s head was so badly injured, it was unlikely that he would have intentionally ignored it. Credit. Richard Shotwell/Invision, via Associated Press
Feb. 11, 2022
Bob Saget, the comedian and actor, died after what appeared to be a significant blow to the head, one that fractured his skull in several places and caused bleeding across both sides of his brain, according to an autopsy report released on Friday.
The findings complicated the picture of Mr. Saget’s death that has emerged in recent days: Far from a head bump that might have been shrugged off, the autopsy described an unmistakably serious set of injuries that would at the very least have probably left someone confused, brain experts said.
The report, prepared by Dr. Joshua Stephany, the chief medical examiner of Orange and Osceola counties in Florida, ascribed Mr. Saget’s injuries to a fall.
“It is most probable that the decedent suffered an unwitnessed fall backwards and struck the posterior aspect of his head,” Dr. Stephany wrote, referring to the back of the skull.
Still, the autopsy left a number of unresolved questions about how exactly Mr. Saget, 65, was so badly hurt. He was found dead in a hotel room at the Ritz-Carlton Orlando, Grande Lake on Jan. 9 during a weekend of stand-up comedy acts. His family said this week that the authorities determined that he had hit his head, “thought nothing of it and went to sleep.”
If the actor struck his head hard enough, and in just the wrong place, it is possible that fractures would have extended to other parts of his skull, brain injury experts said. Situations where someone cannot break their fall are even more dangerous.
“It’s like an egg cracking,” said Dr. Jeffrey Bazarian, an emergency physician and concussion expert at the University of Rochester Medical Center. “You hit it in one spot, and it can crack from the back to the front.”
But experts said that with such an extensive injury, it was unlikely that Mr. Saget would have intentionally ignored it. The injury would likely have left him confused, if not unconscious.
“I doubt he was lucid,” Dr. Bazarian said, “and doubt he thought, ‘I’m just going to sleep this off.’”
Some neurosurgeons said that it would be unusual for a typical fall to cause Mr. Saget’s set of fractures — to the back, the right side and the front of his skull. Those doctors said that the injuries appeared more reminiscent of ones suffered by people who fall from a considerable height or get thrown from their seat in a car crash.
The autopsy, though, found no injuries to other parts of Mr. Saget’s body, as would be expected in a lengthier fall. The medical examiner ruled that the death was accidental. The local sheriff’s office had previously said there were no signs of foul play.
“This is significant trauma,” said Dr. Gavin Britz, the chair in neurosurgery at Houston Methodist. “This is something I find with someone with a baseball bat to the head, or who has fallen from 20 or 30 feet.”
Dr. Britz noted that the autopsy described fractures to particularly thick parts of the skull, as well as to bones in the roof of the eye socket. “If you fracture your orbit,” he said, referring to those eye bones, “you have significant pain.”
The knock ruptured veins in the space between the membrane covering the brain and the brain itself, causing blood to pool, the autopsy indicated. The brain, secured in a hard skull, has nowhere to move, doctors said, and the result is a compression of brain centers critical for breathing and other vital functions.
No alcohol or illegal drugs were detected in the actor’s system, according to the autopsy. But there were signs of Clonazepam, commonly known as Klonopin, a benzodiazepine that is used to prevent seizures and treat panic attacks. Tests also found Trazodone, an antidepressant, the report said.
There was no indication in the autopsy findings that either of those drugs might have contributed to Mr. Saget’s injuries. But doctors said that they could make people sleepy and contribute to a fall.
Benzodiazepines are widely prescribed for older people, despite warnings about the side effects. People who take them face increased risks of falls and fractures, of auto accidents and of reduced cognition.
Use of multiple drugs “is a very dangerous cause of falls in the elderly,” said Dr. Neha Dangayach, the director of neuro-emergencies management and transfers for the Mount Sinai Health System. She said that some combinations could cause drops in blood pressure or confusion.
The report noted that Mr. Saget had an enlarged heart, but did not suggest any link to his death. It also found signs of the coronavirus on a PCR test, but did not suggest that the virus contributed to Mr. Saget’s death. The actor said on a podcast in early January that he had contracted the virus, without specifying exactly when. PCR tests can show the presence of the virus days or even weeks after someone has recovered.
Mr. Saget, best known for his role on the sitcom ‘Full House’ and for hosting ‘America’s Funniest Home Videos,’ thanked the “appreciative audience” of his stand-up comedy set in a Tweet early in the morning on Jan. 9, the day of his death.
“I had no idea I did a 2 hr set tonight,” he said. “I’m happily addicted again to this.”
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