After Bob Saget’s death, a plea from experts: Err on the side of caution with head trauma

Bob Saget’s death — likely the result of a fall backward, according to a Florida medical examiner — is a reminder of how even brain trauma that seems unremarkable might merit medical attention, experts say.

Authorities concluded that Saget, who was found dead in a hotel room in January, hit the back of his head, “thought nothing of it and went to sleep,” his family announced Wednesday, adding that no drugs or alcohol were involved.

Joshua Stephany, the chief medical examiner of Orange and Osceola counties, confirmed the family’s statement in his autopsy report Thursday afternoon, in which he ruled Saget’s death an accident.

With no witnesses to the hours leading up to his death, neurologists were unable to speculate about Saget’s medical situation. But they said the mindset he found himself in isn’t rare: It’s common for people to minimize head injuries.

“We unfortunately hear this frequently, where people have bad headaches after, and they tend to downplay it,” said Dr. Shazam Hussain, the director of the Cerebrovascular Center at the Cleveland Clinic. “They say, ‘Well, I’ll just see if it gets better,’ and then something catastrophic happens.”

Not every knock to the head requires a trip to the emergency room. The force of the impact plays a role, Hussain said, meaning something as significant as a car accident would need to be evaluated, while walking into ceiling rafters likely wouldn’t.

How someone feels after a head injury is an important indicator of whether they should seek care. A persistent or worsening headache, nausea and vomiting are causes for concern, as is a poor recollection of sustaining the injury, said Dr. Joshua Marcus, a neurosurgeon with Nuvance Health.

Loss of consciousness or droopiness in the face, paralysis in the arms or legs, and difficulty walking or speaking need to be looked at immediately, Hussain said.

“If this feels like the worst headache of your life or anything that feels like a strokelike symptom — it’s better not to wait on that stuff,” he said. “We’ve seen too often that people wait on those to get better. Get it checked out and make sure that you’re safe.”

Untreated head trauma can turn fatal because of swelling that the skull doesn’t have room to accommodate, Marcus said.

“What happens if there’s bleeding or swelling in the brain from a traumatic brain injury, that can lead to increased pressure in the head,” he said. “As there’s increased pressure, it affects your breathing and it can affect your heart rate, and ultimately, you can have a respiratory arrest phenomenon.”

Marcus said that while it’s not incredibly common for people to experience medical emergencies in their sleep after head traumas, doctors advise not going to bed immediately afterward.

“The reality is that bleeding or swelling can progress over time, and that is usually over the first few hours, which is why it’s important to monitor your symptoms for at least a few hours,” he said.

Lying flat to go to sleep also elevates your head pressure slightly, he added, “so it’s better to be upright immediately following a trauma.”

People might have lingering symptoms for a few days after traumatic brain injuries, Marcus said, including headaches, concentration issues or even some vision problems. If the symptoms worsen, that’s an urgent reason to get checked out.

Some people are more prone to complications from minor trauma to the head, the experts said. They include senior citizens, people who are on blood thinners or any antiplatelet medications or those who take aspirin daily.

Overall, Marcus said, it’s better to be safe than sorry. And in most cases, patients will be fine.

“I think it’s important that we remember that the majority of brain injuries that are mild are very recoverable and don’t require any intervention, but we need to be aware of the concerning symptoms and when to seek medical attention,” he said.