What is Talk and Die Syndrome?

Talk and die syndrome is a fairly uncommon syndrome occurring after a head injury. Directly after the injury, and possibly for several hours thereafter, a person appears fine. They may not show signs of concussion or cranial bleeding, and they may be talking and have no difficulty walking or have other symptoms of neural damage. However, as the condition progresses, the person gets suddenly much worse, and damage at this point may be too significant to cure. In these cases, people go from talking and seeming fine, to comas or unconsciousness, from which they may not recover. Total brain death can occur, as happened in the tragic death of actress Natasha Richardson in 2009, after what appeared to be a minor injury to the head while Richardson was skiing.

Generally, when brain injury is suspected, the best to way to rule out potential fatal complications is to perform a computed axial tomography or CAT scan of the brain. This advanced scanning technique can identify if areas of the brain are bleeding or if any type of blood clots have formed that might cause death of brain tissues. Yet it’s not always clear when a CAT scan ought to be performed. Doctors don’t routinely do these for relatively minor head injuries, especially when a person seems otherwise fine, which could prompt talk and die syndrome in a very small percentage of the population.

Some people are at greater risk for talk and die syndrome. People who take blood thinners may have minor head injuries that cause bleeding which takes several hours to manifest. However, because most of these people are talking, they can report that they take medications that might put them at greater risk for slow brain bleeds. Thus, they’re more likely to have a CAT scan done to rule out this condition.

In most cases, the type of brain injury that occurs in talk and die syndrome is called an epidural hemorrhage or an epidural hematoma. The brain is separated from the skull by what is called dura mater, and when a brain injury occurs, blood can leak into the space between dura matter and skull. Enough leakage may result in compression on the brain and ultimately brain death.

One hallmark of the talk and die syndrome is associated with epidural hematoma. This is called a lucid interval. Perhaps right after injury has occurred, a person might lose consciousness and then regain it and seem fine. In reality, they are not so and should have a CAT scan to rule out a brain bleed. Mistaking the lucid interval for wellness is what generally leads to death from this form of injury. If this lucid interval is diagnosed appropriately, brain surgery to stop the bleed and release pressure from accumulating, significantly increases survival rate, and most people, who are diagnosed early will survive this brain injury and make a complete recovery.