HWN Suggests

Intracranial epidural hematomas in the ED

Patients with intracranial epidural hematomas may demonstrate and follow several other clinical histories. Many times patients with an evolving epidural hematoma present with only minor symptoms (e.g., headache, nausea, and vomiting) or, on occasion, no symptoms at all…

The classic lucid interval is not the most common method of presentation or progression of a patient harboring an epidural hematoma.

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Articles of Interest

Epidural hematoma

Hemorrhage into the cranial epidural (or “extradural”) space is one of the oldest recognized and most treatable of all neurosurgical disorders. Neolithic man (10,000 to 7000 BC) utilized skull trepanation for a variety of purposes

Epidural Hematoma Pediatric

Lucid Interval: Unconscious – Awake – Unconscious. Observed in ~ half of surgical EDH’s.

Extradural Haematoma (EDH)

An extradural haematoma is commonly caused by skull trauma in the temporoparietal region, typically following a fall, assault or sporting injury. An EDH is associated with a skull fracture in 75% of cases.

Mannitol for acute traumatic brain injury

Mannitol is a sugar alcohol solution which is sometimes effective in reducing brain swelling after head injury. However, its effectiveness in the ongoing treatment of severe head injury remains unclear. There is evidence that excessive administration of mannitol may be harmful, by mannitol passing from the bloodstream into the brain, where it increases pressure within the skull and worsens brain swelling.

Pediatric Cerebral Herniation

Hypertonic saline is the drug of choice for pediatric raised ICP, is easy to administer, does not require preparation like mannitol dose, and an easy way to remember the initial dose is the rule of 3’s: 3mL/kg over 3 minutes.

Everything You Need to Know About Talk & Die Syndrome

Most of the time, however, talk and die syndrome doesn’t show any signs of injury. Victims may talk, laugh, walk, drive, and act completely normal until the pressure builds too much and impacts the brain. Most victims with undiagnosed epidural hematomas die just hours later.

Talk and Die Syndrome: A Narrative Review

The level of consciousness following head trauma generally correlates with the overall prognosis of an individual. Those patients able to talk (Glasgow coma scale verbal of 4) are expected on consensus, to perform well over time. There is, however, a subset of patients who, despite talking after trauma, deteriorate suddenly and succumb; such an event was labeled as “talk and die” by Reilly et al. in the year 1975. The term “talk and die” is not just a fancy combination of words, but it represents an entire event that comes into attention in its dismal outcome.

Trauma-induced Acute Epidural Hematoma: The Rising Sun in a Progressively Lethargic Man

The ideal management of traumatic brain injury (TBI) patients has been a neglected subset of neurological surgery and emergency medicine for much of allosteric medicinal practices since its existence.

Warfarin Induced Spontaneous Cranial Epidural Hematoma: A Case Report And Review Of The Literature

The occurrence of spontaneous cranial epidural haematoma (SCEH) is rare and its incidence is not known. Typically, there is no history of any head trauma. It is associated with coagulation disorders such as hypofibrinogenemia or thrombocytopenia and in such situations can manifest in a catastrophic fashion.

What is "talk and die" syndrome?

After a seemingly minor fall on the slopes, actress Natasha Richardson is reportedly suffering from a potentially deadly head injury

Resources

International Emergency Medicine Education Project

In the presence of epidural hematoma with the feature of herniation, mannitol can be given with caution that craniotomy and evacuation is going to be done immediately

WikEM

Most commonly secondary to a tear of the middle meningeal artery.