Episode 39: Welcome to Pushing Up Lilies, I'm your host Julie Mattson. In this episode, we take an in-depth look at the physical and neurological signs of head trauma and the ways in which they can manifest in different age groups, from babies to the elderly. We also explore head trauma and the connection to criminal behavior, taking a closer look at the scientific evidence and the real-life case of the Louisville shooter, Connor Sturgeon. Are you ready? Listen in…
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0:06 Welcome to Pushing Up Lilies.
0:08 I'm your host, Julie Mattson.
0:10 Pushing Up Lilies is a weekly True crime podcast with spine tingling, unusual and terrifyingly true stories from my perspective as a forensic death investigator and a sexual assault nurse examiner.
0:24 Do I have some stories for you?
0:26 Are you ready?
0:30 Coming to y'all this week from Isla Mujeres, which is an island off of Cancun in Mexico.
0:37 Got here a couple of days ago and absolutely love it.
0:40 It's beautiful.
0:41 We've rented a golf cart so we can kind of drive around town and experience some of the amazing food.
0:48 The water is beautiful here and we've spent quite a bit of time at the pool trying to soak in a little bit of sun and just really relaxing and trying to get away from everything for five days or so.
1:00 That's where we're coming to you from this week.
1:03 I'm taking a break from the pool to record and I wanted to talk a little bit about, we talked about Conor Sturgeon, the Louisville shooter at the bank, his history of concussions while playing football and the fact that he was injured so badly and so frequently that he had to wear a helmet when he played basketball, which you just don't see that could have affected his change in personality.
1:33 Perhaps we talked about how he was a great student.
1:37 He was a great athlete.
1:38 He was very well liked, possibly the most popular kid in his high school.
1:44 But brain injuries and concussions are something that we deal with literally daily in our office.
1:52 Now, we always think that people are resilient.
1:57 And how many times when your child was young, did they fall off a couch or fall just walking and hit their head or bump their teeth?
2:09 We all literally freaked out.
2:12 And when I did telephone triage, we used to get phone calls all the time about kids that fell, fell off, a barstool fell off a couch, fell out of their baby bed trying to get out just different things.
2:24 And of course, we've all heard the horror stories about dressers and televisions that fall on kids and have caused death, which would be horrifying.
2:34 But we deal with concussions and traumatic brain injuries in our office all the time.
2:41 And as a matter of fact, last week I brought a gentleman in, in his nineties.
2:47 The reason I brought him to the medical examiner's office for evaluation was because although he had a significant medical history, he had fallen while getting his mail the day before and hit his head somehow on the concrete and he had a big bruise on his left jaw because he died so quickly.
3:11 After the fall, I wanted to rule out trauma.
3:15 I feel like we owed him that we need our doctors to look at him and determine if he had some head trauma that could have contributed to his death.
3:24 Also because he had a history that required him to take blood thinners.
3:30 So he was on a couple of different blood thinners, of course, can increase the risk of bleeding.
3:35 And so knowing that and given his age, we brought him in for evaluation, I do not yet know the results of his autopsy.
3:45 However, I somewhat expect it to be ruled an accidental death due to the fall instead of a natural death related to his medical conditions.
3:57 And we do deal with little people falling all the time.
4:02 I mean, even adults, my age falling from ladders or falling from roofs, we have several weekly that have experienced falls and injuries and some death.
4:16 A brain injury is a brain dysfunction actually caused by an outside force.
4:22 It can be caused from a violent blow to the head and it normally is a result of injuries while someone is playing sports or injuries in a car accident.
4:35 So a bump blow or jolt to the head or some sort of penetrating injury.
4:42 Now, mild traumatic brain injury and concussion can actually cause the brain to bounce around or twist in the skull.
4:52 You wouldn't think that that could happen.
4:55 However, it does and it can cause a lot of issues that we'll talk about later.
4:59 But it can also cause chemical changes and damage to the brain cells.
5:04 And it can affect how you feel and learn and think and act and even sleep.
5:12 So, repeated concussions can even cause more severe symptoms.
5:17 Ongoing issues with memory headaches, ongoing problems with concentration problems keeping your balance and a brain injury during childhood can affect brain development.
5:33 It can disrupt development and cause changes in health that keep people from becoming productive adults.
5:42 Which is kind of scary.
5:44 Again, we've all had issues where our kids fail and questioned.
5:49 Should we take them to the doctor?
5:50 Should we take them to the hospital?
5:52 Should we just watch them now, back to elderly?
5:56 You know, brain injuries can actually be missed.
6:00 I always say we should wrap little old people in bubble wrap because bless their heart, they're so precious.
6:07 And when they have dementia and they try to get out of bed and fall or a lot of us have experienced our parents getting elderly and not wanting to give up their independence and thinking that they can walk without a walker or trying to get up and go to the bathroom by themselves and hanging on to the wall and falling on the carpet or slipping.
6:31 It's just scary because it happens so much.
6:35 They're at risk for fall and also they could have a car accident that seems minor, however, it can affect them a little more than the average person for different reasons.
6:48 Now, when the elderly are on blood thinners, perhaps they have a history of atrial fibrillation, they may be on blood thinners.
6:55 So that's also gonna increase their risk of bleeding.
6:58 75 and older have the highest rates of traumatic brain injury related hospitalizations and deaths.
7:06 Now, males are also two times more likely to be hospitalized and three times more likely to die.
7:13 I think y'all are just a little more dangerous, maybe just, you know, pushing things to the edge a little bit, trying to compete with your friends or you know, hold my beer and watch this type stuff going on.
7:28 Children from birth to age 17, had 16,070 traumatic brain injury related hospitalizations in 2019.
7:39 So that tells you that everybody's really at risk.
7:43 The main reason I think with younger Children is because they can't voice how they feel as far as having a headache or understanding what a headache is, especially if they're babies naturally.
7:55 And elderly people with dementia honestly are a little bit weak and can't get up on their own.
8:03 So many, many times they're found on the floor.
8:06 I think a lot of times it's kind of brushed under the rug and maybe not shared with family.
8:12 If there's no obvious injuries like bruises, even though they very well may have hit their head and just not bruised.
8:20 We always wonder, you know, why the elderly don't recover.
8:23 I know that even with what appears to be a simple fall to us, I've fallen 1000 times, but they don't heal quickly because their bones don't remodel like they did when they were younger, their wounds don't heal.
8:41 Glycemic control is an issue.
8:44 And they're also at increased risk of infections and complications from surgery if they were to have surgery, if they're elderly and maybe their heart won't withstand surgery.
8:57 That's another issue that could very well take place.
9:01 Over 65 anyone, over 65 loses about 8% of muscle mass every day that they're in bed unable to move.
9:11 So, 8% y'all, I mean, that's a lot and we wonder why these little elderly people don't recover from falls.
9:20 And I'm not talking about just hitting their head but also just falling, breaking a hip.
9:25 I've seen little people walk around with a broken hip and not even know it many times because they have illnesses that cause neuropathy and they just can't feel the pain.
9:34 So it does happen.
9:36 We're all at risk and I just felt the need to kind of talk a little bit about the brain injury issue and then go into, you know why we do have so many elderly that die after falls.
9:48 So, a type of traumatic brain injury is called a subdural hematoma.
9:53 And we do get a lot of calls in our office about people who experienced a subdural following a car accident or following a fall.
10:02 And this actually occurs within the skull, but outside the actual brain tissue and usually there's a tear in a blood vessel.
10:11 It occurs in about 25% of people with head injuries.
10:15 So that's a pretty high percentage when you think about it.
10:18 And we're talking about all ages.
10:21 Usually it's a slow bleed.
10:23 And for most people with not a lot of medical history, your body can absorb that blood.
10:30 But if severe pressure builds up on the brain, it can cause a lot of problems.
10:37 And you don't always know immediately.
10:40 So that's why sometimes even when you hit your head, if you think you're ok, you may not be.
10:46 We all remember or I do.
10:48 Anyway, the story about Natasha Richardson, she was married to Liam Neeson.
10:54 She, I think ran into a tree skiing and thought she was fine.
10:58 Had a little bit of a headache, didn't get checked out and actually died hours later.
11:03 She was my age.
11:05 She thought she was fine.
11:08 She may not have hit the tree that hard, but you don't always know immediately.
11:13 You don't always feel severe pain, that indicates something's wrong.
11:18 It's always best to get checked out.
11:20 I mean, it's not hard to go to the hospital.
11:23 Have a cat scan, let the doctor look at you and make sure that you're ok because it's just peace of mind is better than not knowing.
11:33 Now, acute subdual's are right after the injury.
11:38 This is when the symptoms are severe.
11:41 They occur very quickly and there's not a lot of time at that point to get help.
11:48 A sub acute is when symptoms appear hours days or sometimes weeks after injury.
11:55 And this can occur with a concussion, especially when it occurs over and over in like sports.
12:03 A chronic subdural hematoma is more common in the elderly and this is when the bleeding is slow.
12:12 It occurs over again, sometimes days or weeks because a lot of them have dementia, their mental changes are very subtle.
12:22 We don't always notice, I know that we experienced a lot of elderly with urinary tract infections and one of the first symptoms that we see in the elderly that have a U T I is altered mental status.
12:36 You wouldn't think so, but the infection, that's just how it affects them.
12:40 They may already have dementia.
12:42 And so you may not really notice a big change in the mental status because it may already be declining.
12:49 It's definitely always worth it to have the elderly checked out, especially if they're on blood thinners.
12:58 Now, the risks are for them that the older you get your brain actually shrinks and the area between your skull and your brain actually widens.
13:11 So there's more space there, veins that are, there are very thin and they stretch even without hitting your head, but maybe just the back and forth motion of falling can actually cause those veins to stretch and cause bleeding.
13:29 Athletes suffering repeated blows to the head, of course, are at high risk and people are blood thinners.
13:39 Now, blood thinners are gonna slow down or prevent blood from clotting.
13:44 These are given a lot of to people who have certain heart arrhythmias and they have to take them, their doctors monitor their levels to make sure they don't take too much.
13:55 But still even on a therapeutic dose, their risks are higher because their blood is thinner.
14:02 People who are hemophilia's, they have inherited bleeding disorders that prevent clotting.
14:08 So these people are also at very, very high risk of being injured in a fall.
14:15 Babies have very weak neck muscles and so many times when they have sudden movement of the head, shaken baby syndrome, they may have headaches, confusion, nausea, vomiting, toddlers would have slurred speech, maybe vision changes, dizziness, weakness and swelling of the brain would cause an enlarged head in a baby.
14:45 Anybody could have personality changes as well.
14:49 But the scary thing is like I talked about earlier, sometimes there are no symptoms at all.
14:56 Elderly people with dementia and Alzheimer's and babies who are unable to speak.
15:03 They can't tell you, they can't tell you how they're feeling.
15:06 I feel like although a lot of people may not be candidates for surgery if we take falls a little more seriously, perhaps we could prevent as many deaths as we have now related to them.
15:21 Now, a bleed in the brain can actually be caused by trauma, but it can also be spontaneous.
15:27 Like a lot of people will have a stroke or an aneurysm and those aren't necessarily due to any kind of fall, but they're spontaneous.
15:36 They just happen.
15:38 Aneurysms can cause headaches, strokes can cause things like arm numbness or facial drooping or numbness on one side of the face or even blindness in one eye.
15:53 There's a lot, a lot of issues that we deal with every day at the office related to falls.
16:01 We have had people fall like perhaps in construction.
16:06 Not too long ago, I had a gentleman who was a roofer.
16:10 He wasn't feeling well on this particular day, he wrote to work with his nephew and voice that he just didn't feel great.
16:18 Perhaps it was allergies.
16:19 He didn't know he was a little bit dizzy, a little bit nauseous, but he got on the roof, what he was doing.
16:28 But I feel like when he was on the roof, he probably had some sort of coronary event or something that caused him to collapse and he actually fell off the roof and then landed on some rocks that were down below.
16:43 When I got there, it was obvious he had a head injury and of course, it killed him instantly.
16:49 But this kind of stuff happens all the time as well.
16:54 Many times we'll come up on a scene where, like I said, it's a car accident and obviously they have head injuries or injuries to some part of the body that are not compatible with life.
17:05 But it seems like in the little old people that the injuries are not detected as often because they're kind of, I don't know, I don't wanna say that nursing homes are busy and they maybe don't necessarily report every incident to the family.
17:22 And of course, as the family, we can't be there all the time and they do have alarms for their beds.
17:28 So they know when they try to get up and of course, a lot of people know that they should be walking with a walker, but they're very independent and they just don't want help.
17:39 I just think that it is important to make sure that everybody gets checked out.
17:45 I think that there could be a hairline fracture somewhere that can cause later issues.
17:52 They're just not gonna recover like they did before.
17:56 The sad part is they have a lot of medical problems and if they just died of natural causes at home, the medical examiner or the coroner would not have to get involved.
18:07 But because of the injuries from the fall that actually could cause their death to be ruled an accident and it could be due to head trauma.
18:19 That's why I thought with the Connor Sturgeon issue and us talking about him having concussions that it might be important to kind of talk a little bit about what can happen when someone falls.
18:33 And again, when your brain shrinks as you get older, especially if you're on blood thinners, your risk is super, super high.
18:40 I told my husband one way to prevent your brain from shrinking is to get regular exercise.
18:47 And so we have decided we don't want our brains to shrink.
18:50 So we are gonna start walking regularly and getting back into some type of exercise regimen.
18:58 I think that's important to prevent a lot of diseases that we see people die with every day diabetes.
19:05 I myself had gestational diabetes with my first pregnancy.
19:09 I was running three miles a day when I got pregnant with my second daughter and I did not have gestational diabetes during that pregnancy.
19:16 Now, my parents both were diabetic and because I have had gestational diabetes that puts me at very, very high risk.
19:24 But I also have seen firsthand that exercise is going to very much reduce my chances of being diagnosed with diabetes.
19:34 So I think although prevention is not always possible, we're trying to prevent things from happening.
19:42 And it's just important to realize what we need to do to keep ourselves healthy and watch out for our little elderly people.
19:51 And of course, babies, we always hate to go on deaths where babies have fallen or family may say that they fell off a couch and we can tell because of their injuries that they have been shaken or injured by an adult.
20:07 It's super sad.
20:08 It's never something that we like to go on.
20:13 You know, the hardest part for me is knowing that someone in the room hurt this child and not being able to say anything because if you do, they're gonna clam up and they're not going to give you any information at all.
20:26 And of course, we have to be very careful not to mess up the police investigation in issues like that.
20:33 Thank you so much for joining me today on Pushing Up Lilies.
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