Natasha Richardson cause of death determined

The cause of death was epidural hematoma (bleeding between the skull and the brain's covering), said Ellen Borakove, a spokeswoman for the New York City medical examiner's office. Richardson was not wearing a helmet and the death was ruled an accident.

An epidural hematoma is often caused by a skull fracture. The bleeding causes a blood clot that puts pressure on the brain. That pressure can force the brain downward to press on the brain stem that controls breathing and other vital functions, causing coma or death. Frequently, surgeons cut off part of the skull to give the brain room to swell.

Richardson, 45, died Wednesday at Lenox Hill Hospital in Manhattan after falling at the Mont Tremblant resort in Quebec on Monday. Descended from one of Britain's greatest acting dynasties, including her mother, Vanessa Redgrave, Richardson was known for her work in such plays as "Cabaret" (for which she won a Tony) and "Anna Christie" and in the films "Patty Hearst" and "The Handmaid's Tale."

The mourning continued Thursday as Broadway theaters intended to dim their lights in honor of Richardson and colleagues offered tributes. Fitting for an actress of Hollywood beauty and classical training, praise came from both tabloid celebrities - "The Parent Trap" co-star Lindsay Lohan - and artists of the theater, like Sam Mendes, who directed the 1998 revival of the Broadway musical "Cabaret."

"It defies belief that this gifted, brave, tenacious, wonderful woman is gone," said Mendes, also known as the director of the Academy Award-winning "American Beauty."

Theater marquees will be dimmed for one minute at 8 p.m., the traditional starting time for evening performances of Broadway shows.

Richardson gave several memorable stage performances, more than living up to some of the theater's most famous roles: Sally Bowles of "Cabaret," Blanche DuBois of "A Streetcar Named Desire" and the title character of Eugene O'Neill's "Anna Christie," a 1993 revival in which she co-starred with future husband Liam Neeson.

(They have two sons: Micheal, 13, and Daniel, 12.) "The Broadway community is shocked and deeply saddened by the tragic loss of one of our finest young actresses, Natasha Richardson. Her theatrical lineage is legendary, but her own singular talent shined memorably on any stage she appeared," said Charlotte St. Martin, executive director of The Broadway League, the trade organization for Broadway theaters and producers.

Richardson's shocking death greatly heightened the debate over skiing safety. Quebec, for instance, is considering making helmets mandatory on ski hills. Jean-Pascal Bernier, a spokesman for Quebec Sport and Leisure Minister Michelle Courchesne, said Thursday the death of Richardson at a Quebec resort has added impetus to plans but says they it was already on the table.

Bernier says the minister met with emergency room doctors this week and will meet with Quebec ski hill owners and operators in the coming weeks.

Emergency room doctors in the province first called for mandatory use of helmets three weeks ago. Yves Coderre, director of operations at the emergency services company that sent paramedics to the Mont Tremblant resort where Richardson suffered her fall, told The Globe and Mail newspaper Wednesday the paramedics who responded were told they were not needed.

"They never saw the patient," Coderre said. "So they turned around."

Coderre said another ambulance was called later to Richardson's luxury hotel. By that point, her condition had gotten worse and she was rushed to a hospital.

Richardson said she felt fine after her spill but became ill later and complained of a headache. Doctors say sometimes patients with brain injuries have what's called a "lucid interval" where they act fine for an hour or more as the brain slowly, silently swells or bleeds.

Symptoms- headache; loss of consciousness; vomiting; problems seeing, speaking or moving; confusion; drainage of a clear fluid from the nose or mouth - appear after enough pressure builds in the skull.

Emergency surgery is often need to drain the blood or remove the clot.

"This is a very treatable condition if you're aware of what the problem is and the patient is quickly transferred to a hospital," said Dr. Keith Siller of New York University Langone Medical Center. "But there is very little time to correct this."