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Dr. Marc Lévêque (Neurosurgery – Pain)
Gaspard Ulliel died on Wednesday January 19, following a skiing accident that occurred the day before at La Rosière en Savoir resort. He was 37 years old. In a relationship with model Gaëlle Pietri, he leaves behind his 6-year-old son Orso. Shortly before 4 p.m., the actor was transported by helicopter to the Grenoble University Hospital. The collision with another skier occurred at the crossing of two blue runs. The state of the actor was considered very critical from the outset. How are these head injuries treated? What are their consequences? Dr. Marc Lévêque, neurosurgeon and member of the expert committee of Doctissimo answers us.
Can we know what died of Gaspard Ulliel?
Dr. Marc Leveque: It’s hard to say with certainty. Based on the available evidence, we can assume that it is a serious head injury that occurs after a very severe shock to the head and skull. A shock whose consequences could be increased if the skier did not have a helmet.
The severity is assessed on the basis of the symptoms: is the patient conscious or immediately unconscious? The state of coma is assessed using a standardized scale: the Glasgow score based on the patient’s verbal and motor response and eye movement. The person may be confused, drowsy, agitated… Being unconscious from the outset, as seems the case for Gaspard Ulliel, is a less good prognostic factor.
The severity is then based on anatomical data: the results of an MRI scanner are used to assess the lesions.
What are the mechanisms that can lead to death?
Concretely, in the event of an injury, the brain can bleed or swell due to the accumulation of fluid, we speak ofintracerebral hematoma. This hemorrhage and this edema will increase the pressure on the brain which will swell inside the cranial box which is not extensible. In fact, when the intracranial pressure increases, the symptoms worsen and others may appear: headaches, increasing confusion, vomiting, epileptic seizures… The less oxygenated brain will also produce toxic substances which will participate in the edema and increase the damage in a vicious circle that must be stopped as soon as possible.
The priority is to rely on specialized intensive care units, as is the case at the Grenoble University Hospital.
In the event of a lesion, the hematoma must be evacuated, which contributes to the increase in intracranial pressure.
To reduce the intracranial pressure, we may have to perform a decompressive craniectomy: we will open the cranial box to reduce the pressure.
Intracranial pressure is monitored using sensors: a small catheter fitted with a manometer can be introduced into the skull to measure it. It also makes it possible to evaluate the effectiveness of the treatment in reducing the rise in pressure in the brain. For this, we can resort to drugs (such as mannitol) which will increase the excretion of liquids.