'Talk and die' syndrome not common, doctor says

In "talk and die" syndrome, people can have what seems to be a mild blow to the head appear perfectly lucid and then within hours lapse into a coma -- which is what reportedly happened to actress Natasha Richardson after she fell on a Canadian ski slope Monday.

"It is not a very common occurrence," Dr. Steven Flanagan, medical director of the Rusk Institute of Rehabilitation Medicine at New York University Langone Medical Center, said Wednesday. "A patient comes into the emergency room talking and then rapidly deteriorates" as blood pools and puts pressure on brain tissue.

Flanagan and other doctors speculated that Richardson could have had an epidural hematoma.

Usually caused by a trauma such as a fall, blood builds up between the cover of the brain, called the dura, and the skull. Blood trapped inside the "closed box" of the skull can compress brain tissue, which can cause pressure on vital functions, said Dr. Henry Woo, associate professor of neurological surgery and radiology at Stony Brook University Medical Center.

A CT scan is the best way to diagnose a brain injury, said Dr. Ashesh Mehta, a neurosurgeon at North Shore-Long Island Jewish Health System. Like other doctors, he said anyone who has had a blow to the head should be watched for changes in his or her condition.

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