Concepts
Patients who talk and deteriorate

https://doi.org/10.1016/S0196-0644(05)82742-8Get rights and content

Patients who “talk and deteriorate” are defined as those who utter recognizable words at some time after head injury and then deteriorate to a severe head-injured condition (Glasgow Coma Scale score of 8 or less) within 48 hours of injury. They represent a very small but important subgroup of patients with brain injury. In approximately 75% of these patients, the cause of this deterioration is intranial hematoma. Despite the fact that talking indicates nonlethal impact brain injury, deterioration is a marker of poor prognosis. Outcome depends on early recognition of deterioration and rapid removal of mass lesions. The challenge for emergency physicians is to distinguish patients at risk for deterioration from the many patients evaluated after head injury.

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      Two trials are currently ongoing: the RESCUEicp (Randomised Evaluation of Surgery in Craniectomy for Uncontrollable Elevation of Intracranial Pressure) Study in Europe and the DECRA (Decompressive Craniectomy) Study in Australia.103 Many patients develop progressive damage without clear clinical signs; in others, damage develops at an alarming pace, exemplified by the so-called “talk and die” syndrome.104,105 Neuroworsening, defined as a deterioration of the GCS motor score, development of pupillary abnormalities, or development of progressive CT lesions, has been reported in 29–44% of patients.106–108

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    Presented at the Neurotrauma: Concepts, Current Practice & Emerging Therapies symposium in Detroit, Michigan, June 1992.

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