Natasha Richardson
WIKIMEDIA COMMONS/KHEDARA

Last night, British-born actress Natasha Richardson, 45, was rushed from Montreal to New York City in critical condition after a seemingly minor fall on a Quebec ski slope apparently led to bleeding in her brain.

Richardson, who won a Tony for her role in the Broadway play Cabaret and has also starred in a string of films including The Parent Trap and Maid in Manhattan, is the daughter of actress Vanessa Redgrave and the wife of actor Liam Neeson, 56, with whom she has two sons, ages 12 and 13. She was reportedly taking a skiing lesson on a beginner slope at the Mont Tremblant resort some 80 miles (130 kilometers) northwest of Montreal when she took a spill.

"It was a normal fall," Lyne Lortie, a Mont Tremblant spokesperson told The New York Times, "She didn't show any signs of injury; she was talking and she seemed all right."

Still, her instructor summoned the ski patrol to transport her to the bottom of the hill in accordance with the resort's safety policies. Richardson reportedly refused medical care when an ambulance arrived and went back to her hotel room. About an hour later, however, Lortie said that Richardson complained of a severe headache; she was rushed by ambulance to Hôpital Sacré-Coeur in Montreal, where Neeson met her after flying in from Toronto where he was filming a movie. The actress was then flown by private jet to Lenox Hill Hospital in Manhattan, where she and Neeson have an apartment on the Upper West Side.

The family had not issued a statement at deadline and no reports on her condition had been confirmed. However, some media outlets, citing anonymous sources, claim that the actress had been on life support but was removed from it today and was not expected to survive. "It's so sad. Vanessa, her sister Lynn, everybody is gathering in New York to say goodbye," a "close friend" of the family told London's Daily Mail. "No one can believe what has happened, that this once vibrant woman, full of love, of life, is lying there brain dead."

The tragic story, if confirmed, is a reminder that even minor blows to the head can lead to devastating bleeding that can cause strokes or otherwise damage brain tissue. One possibility, sometimes called "talk and die" syndrome, is that the actress had delayed bleeding between her skull and her brain stem, which sits at the top of the spinal cord and regulates consciousness, breathing, and the heart and connects the brain to many of the body's sensory and motor nerves. Another possibility is that there was a tear in the inner lining of her arteries, causing blood clots. To find out more about Richardson's potential injury, we spoke with neurosurgeon   Keith Black, chairman of the Department of Neurosurgery at Cedars-Sinai Medical Center in Los Angeles.

[An edited transcript of the interview follows.]

Based on Richardson's symptoms, what kind of injury do you think she suffered?
The possibilities range from what we call an arterial dissection to a preexisting condition that might have been triggered by the event. An arterial dissection is where patients have a very mild injury tear the inner lining of the arteries of the neck, either the carotid or vertebral arteries, and that can occur with even minor trauma that one may not believe to be significant. That tearing in the artery can cause clotting, which can set up a stroke (an interruption of the brain's blood supply caused by a blockage or a rupture of a blood vessel). If that clot is in the vertebral artery system, it can cause a stroke in the brain stem, which can be devastating.

The other possibility is delayed bleeding in the brain. That can be from either a tear in a vein or an artery in the brain tissue itself, and that can be either an epidural hematoma (between the skull and the dura, the membrane that surrounds the brain) or a subdural hematoma (between the dura and the brain).

Another possibility is that she had a condition that predisposed her to having a more catastrophic event. This could be an abnormality in how fast her blood clots after a bleed. Or if she's been on any aspirin, blood thinners, or, supplements like omega-3 fish oil, that can make things worse.   The other thing one has to worry about is whether she had a vascular abnormality in the brain like an arteriovenous malformation (an abnormal connection between high-pressure arteries and low-pressure veins). If an AVM tears one can get a more significant bleed.   

I think the two most likely conditions would either be the arterial dissection in the neck or the delayed bleeding within the brain itself.