Abstract
'Talk and die' patients are a small number of patients who present with a mild head injury (Glasgow coma scale [GCS] 13-15) and then subsequently deteriorate and die from intracranial causes. We report the case of a 60-year-old man who had the first mild head injury, followed by chronic subdural hematoma and finally suffered from the high-energy second head injury and was ambulated to our hospital with a GCS of 15. He presented with severe headache and uncontrollable high blood pressure but he could talk. Computed tomographic scans showed a small brain contusion and traumatic subarachnoid hemorrhage (SAH) in the right temporal lobe, the left frontal lobe, and the anterior interhemispheric space around the pericallosal artery.
Highlights
Et al first introduced the term ‘talk and die’ in 1975, before the advent of computed tomographic (CT) scans to describe the small number of patients who present with a mild head injury (GCS 13-15) and subsequently deteriorate and die from intracranial causes [1]
Several clinical practice guidelines (CPGs) have been issued [7,8,9,10,11,12,13]. They state that patients who have incurred a mild head injury and have a glasgow coma scale [GCS] score of 13-15 on their initial evaluation and imaging evidence of traumatic subarachnoid hemorrhage (SAH) and/or intraparenchymal contusion do not require a neurosurgical consultation or transfer to tertiary care center and can be safely discharged [713]
A prospective cohort study conducted in Canada that included consecutive adults who presented with a GCS score of 13-15 after head injury revealed that 8% of the patients had a clinically important brain injury and only
Summary
Et al first introduced the term ‘talk and die’ in 1975, before the advent of computed tomographic (CT) scans to describe the small number of patients who present with a mild head injury (GCS 13-15) and subsequently deteriorate and die from intracranial causes [1]. Several clinical practice guidelines (CPGs) have been issued [7,8,9,10,11,12,13] They state that patients who have incurred a mild head injury and have a glasgow coma scale [GCS] score of 13-15 on their initial evaluation and imaging evidence of traumatic subarachnoid hemorrhage (SAH) and/or intraparenchymal contusion do not require a neurosurgical consultation or transfer to tertiary care center and can be safely discharged [713]. After the seizure and the respiratory control, it was 2.5 hr after the patient’s fall/head injury, a second CT examination revealed massive bifrontal and right temporal lobe hematomas and a massive SAH (Figure 4).
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