Bob Mackie, the 'King of Camp' designer, died after a fall, not simply from pneumonia as first reported. According to a death certificate obtained by Us Weekly, the 87-year-old had a subarachnoid haemorrhage and blunt head trauma listed as the immediate cause.

He fell on 11 September at the home of his long-time design director, Joseph McFate. He died three days later, on 14 September.

Fall Led to Brain Bleed

Mackie died at Desert Regional Medical Center in Palm Springs, California. His representative, who had initially said he died of pneumonia, said a medical professional was with him when he fell and that he had pneumonia before and after his hospitalisation.

Cleveland Clinic says subarachnoid haemorrhages caused by injury most commonly affect older people who have fallen and hit their heads. Overall, however, the most common cause is a ruptured brain aneurysm, while head injuries are another recognised cause.

What a Subarachnoid Haemorrhage Is

A subarachnoid haemorrhage is bleeding in the space between the brain and the thin tissues that cover and protect it. The Mayo Clinic says it is a type of stroke, and it is regarded as a medical emergency.

It differs from a subdural haematoma, where blood leaks below the outermost membrane layer. In a subarachnoid haemorrhage, blood leaks below the arachnoid layer, and both conditions can cause brain damage.

The condition is rare, with about 10 to 14 out of 100,000 people in the United States experiencing one each year. It most commonly affects people between the ages of 40 and 60.

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Symptoms, Diagnosis and Treatment

The main symptom is a thunderclap headache, an extremely painful headache that comes on suddenly. Other signs include nausea, vomiting, a stiff neck, dizziness, confusion, seizures and light sensitivity.

A subarachnoid haemorrhage is life-threatening. Emergency care should be sought at once for a thunderclap headache, especially when other symptoms appear.

Diagnosis typically begins with a CT scan. If the scan is negative, doctors may order a lumbar puncture or a brain MRI to detect bleeding.

Treatment typically takes place in an intensive care unit at a hospital with neurological expertise. Care may include life support, a draining tube to relieve pressure and medication to control swelling and seizures.

Treatment depends on the cause and severity of the haemorrhage. Patients may need close neurological monitoring, treatment to control pressure inside the skull, or surgery or other procedures to address the underlying cause and prevent further bleeding.

Risks and Long-Term Recovery

Harvard Health Publishing says blood from the haemorrhage mixes with the cerebrospinal fluid that cushions the brain, raising pressure around it. That pressure can interfere with brain function.

In the hours and days after the bleeding, chemical irritation from clotted blood can cause brain arteries to spasm. An artery spasm can, in turn, cause additional brain damage.

Many patients do not survive long enough to reach hospital. For those who do, the prognosis depends on the severity of the initial brain damage, and their condition can change rapidly.

Symptoms caused by a small initial bleed may temporarily improve, but this can be a warning sign of a more serious haemorrhage. A so-called sentinel headache can precede a larger bleed, making urgent medical assessment essential.

The stress on the brain can also trigger chemical changes in the heart muscle. Patients may therefore need heart tests, including an electrocardiogram and echocardiogram, and close monitoring of heart rhythm and function.

Recovery varies according to the severity of the haemorrhage and the extent of the initial brain injury. Some survivors experience lasting neurological difficulties and require rehabilitation.

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