The head-injured child who "talks and dies". A report of 4 cases

The phenomenon of "talking and deteriorating" after closed head injury exists in children. A variety of causes have been identified, few of which are operatively remedial. Four cases of children with head trauma are reported, in each of whom there was an interval during which the child verbalized to some degree. Rapid neurological decline then occurred approximately 30-50 h postinjury in each child, who subsequently died from their trauma. In all instances the children were injured in motor vehicle accidents or falls, had initial Glasgow Coma Scale ratings of 9 or better, and demonstrated irritability and restlessness just prior to their deterioration. In no circumstance was a space-occupying intracranial hematoma present. Post-mortem brain examinations in two of the children showed in common multiple cerebral contusions, brain edema with herniation phenomena and hypoxic-ischemic encephalopathy.