Such an extensive head injury would likely have left the actor confused, if not unconscious, experts said.
Bob Saget, the comedian and actor, died after what appeared to be a significant blow to the head, one that fractured his skull in several places and caused bleeding across both sides of his brain, according to an autopsy report released on Friday.
The findings complicated the picture of Mr. Saget’s death that has emerged in recent days: Far from a head bump that might have been shrugged off, the autopsy described an unmistakably serious set of injuries that would at the very least have probably left someone confused, brain experts said.
The report, prepared by Dr. Joshua Stephany, the chief medical examiner of Orange and Osceola counties in Florida, ascribed Mr. Saget’s injuries to a fall.
“It is most probable that the decedent suffered an unwitnessed fall backwards and struck the posterior aspect of his head,” Dr. Stephany wrote, referring to the back of the skull.
Still, the autopsy left a number of unresolved questions about how exactly Mr. Saget, 65, was so badly hurt. He was found dead in a hotel room at the Ritz-Carlton Orlando, Grande Lake on Jan. 9 during a weekend of stand-up comedy acts. His family said this week that the authorities determined that he had hit his head, “thought nothing of it and went to sleep.”
If the actor struck his head hard enough, and in just the wrong place, it is possible that fractures would have extended to other parts of his skull, brain injury experts said. Situations where someone cannot break their fall are even more dangerous.
“It’s like an egg cracking,” said Dr. Jeffrey Bazarian, an emergency physician and concussion expert at the University of Rochester Medical Center. “You hit it in one spot, and it can crack from the back to the front.”
But experts said that with such an extensive injury, it was unlikely that Mr. Saget would have intentionally ignored it. The injury would likely have left him confused, if not unconscious.
“I doubt he was lucid,” Dr. Bazarian said, “and doubt he thought, ‘I’m just going to sleep this off.'”
Some neurosurgeons said that it would be unusual for a typical fall to cause Mr. Saget’s set of fractures — to the back, the right side and the front of his skull. Those doctors said that the injuries appeared more reminiscent of ones suffered by people who fall from a considerable height or get thrown from their seat in a car crash.
The autopsy, though, found no injuries to other parts of Mr. Saget’s body, as would be expected in a lengthier fall. The medical examiner ruled that the death was accidental. The local sheriff’s office had previously said there were no signs of foul play.
“This is significant trauma,” said Dr. Gavin Britz, the chair in neurosurgery at Houston Methodist. “This is something I find with someone with a baseball bat to the head, or who has fallen from 20 or 30 feet.”
Dr. Britz noted that the autopsy described fractures to particularly thick parts of the skull, as well as to bones in the roof of the eye socket. “If you fracture your orbit,” he said, referring to those eye bones, “you have significant pain.”
The knock ruptured veins in the space between the membrane covering the brain and the brain itself, causing blood to pool, the autopsy indicated. The brain, secured in a hard skull, has nowhere to move, doctors said, and the result is a compression of brain centers critical for breathing and other vital functions.
No alcohol or illegal drugs were detected in the actor’s system, according to the autopsy. But there were signs of Clonazepam, commonly known as Klonopin, a benzodiazepine that is used to prevent seizures and treat panic attacks. Tests also found Trazodone, an antidepressant, the report said.
There was no indication in the autopsy findings that either of those drugs might have contributed to Mr. Saget’s injuries. But doctors said that they could make people sleepy and contribute to a fall.
Benzodiazepines are widely prescribed for older people, despite warnings about the side effects. People who take them face increased risks of falls and fractures, of auto accidents and of reduced cognition.
Use of multiple drugs “is a very dangerous cause of falls in the elderly,” said Dr. Neha Dangayach, the director of neuro-emergencies management and transfers for the Mount Sinai Health System. She said that some combinations could cause drops in blood pressure or confusion.
The report noted that Mr. Saget had an enlarged heart, but did not suggest any link to his death. It also found signs of the coronavirus on a PCR test, but did not suggest that the virus contributed to Mr. Saget’s death. The actor said on a podcast in early January that he had contracted the virus, without specifying exactly when. PCR tests can show the presence of the virus days or even weeks after someone has recovered.
Mr. Saget, best known for his role on the sitcom ‘Full House’ and for hosting ‘America’s Funniest Home Videos,’ thanked the “appreciative audience” of his stand-up comedy set in a Tweet early in the morning on Jan. 9, the day of his death.
“I had no idea I did a 2 hr set tonight,” he said. “I’m happily addicted again to this.”