What Is "Talk and Die Syndrome?"

How the Media Describes an Epidural Hematoma

unconscious bloody male
An epidural hematoma can be present with or without visible injuries. Cornelia Schauermann / Getty Images

Question: What Is "Talk and Die Syndrome?"

I must confess: Before the skiing accident that killed Natasha Richardson, I'd never heard the term "talk and die syndrome." It just wasn't a term used by the caregivers I worked with. The first time I read it however, I knew it described an epidural hematoma.

The media jumped on the term and in the days following Richardson's death, several readers and folks on the street asked me: what exactly is talk and die syndrome?

Answer: Talk and die syndrome is a nickname used by some neurologists and emergency physicians to describe the signs -- or lack of signs -- of an epidural hematoma.

Closed head injuries are brain injuries that happen without any break in the skull. Because the skull remains "closed" there may or may not be visible wounds or bruising on the victim's head. The only way to tell if a person has suffered a closed head injury is by the simple fact they've been hit in the head and by any symptoms they may or may not have.

Epidural hematomas are the most dangerous of all the closed head injuries. Just like concussions, epidural hematomas often don't show any obvious signs of injury. The patient may get knocked out and may not. Patients might complain of headaches or blurred vision, but don't have to for epidural hematomas to be forming. There doesn't have to be any bleeding or bruising, and the only sign of injury may happen many hours -- or even days -- later.

That lapse in time between getting hit in the head and having symptoms -- which could be as minor as a headache or as major as sudden coma -- is what gives this combination the nickname "talk and die syndrome." Patients like Natasha Richardson may get injured and deny any complaints. They may turn away help and profess that they are fine (as Richardson did), all the while quietly bleeding into the space between the brain and the skull.

Richardson's accident showed how dangerous epidural hematomas can be. It may not always be possible to recognize an injury severe enough to cause a closed head injury, but any impact to the head that knocks the patient out or causes blurred vision should be seen at the emergency department.

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