Walk and Die: An Unusual Presentation of Head Injury

Abstract

We report three deaths in young adult males following closed blunt trauma to the head and face where the affected individuals were able to walk away from the incident, before subsequently collapsing and dying a short distance from the site of the assault. In each case, due to the rapidity of the posttrauma collapse, the pathologist was faced with a diagnostic difficulty at autopsy; the external examination revealed multiple injuries to the head and face, but internal examinations showed limited findings with no structural explanation for the death. We discuss possible mechanisms that could account for this scenario, the implications of alcohol consumption with a concussive head injury, and parallels that can be drawn with the so-called "talk and die,""talk and deteriorate," and "second impact syndrome." Finally, the possible role of so-called "postexercise peril" is discussed in relation to these deaths.

Neuroimaging in Mild Traumatic Brain Injury

“…Figure 3, from Levine et al (2008), shows the application of quantitative neuroimaging to assess the overall structural integrity of the brain following injury and shows the effect of TBI injury severity on atrophic changes (brain volume loss) that occur, including those associated with mTBI. Brain atrophy occurs in some cases of mTBI (see Cohen et al 2007;Inglese et al 2005Inglese et al , 2006MacKenzie et al 2002) because, even in mTBI, cell death or injury that results in cellular damage may result as a consequence of the trauma, as shown in animal and human studies (Dikranian et al 2008;Tashlykov et al 2009;Teresa et al 2009;(Blumbergs et al 1994;Veevers et al 2009;Viano et al 2009). …”

What Definition Is Used to Describe Second Impact Syndrome in Sports? A Systematic and Critical Review

“…Twelve articles (13%) included a statement where the definition could be interpreted as merely two consecutive concussions, that is, a concussion in an individual who has had a prior concussion that has not completely resolved. In these articles, many had the following statement, "The second impact syndrome has been defined as occurring when an athlete who has sustained an initial head injury, most often a concussion, sustains a second injury before symptoms associated with the first have fully cleared" (64,91,92,95). These articles generally led back to a 1995 article by Cantu (20) which, interestingly, did not have the term "define" or any related term in the description.…”

“…The vast majority were review articles repeating rates cited by case reports. Four manuscripts described these cases and discussed causes of death (20,40,69,95). Among the articles that listed mortality rates, nearly all (33/35, 94%) said the rate of death was either "high," "about 50%," "50% to 100%," or "100%.…”

Trending Issues and Long-Term Effects of Recurrent Concussion in Sport

“…It appears as though a good majority of the SIS literature prevails on the adolescent patient (e.g., Cantu & Gean, 2010;Caskey & Nance, 2014;Grace, 2013;Simma et al, 2013;Veevers, Lawler, & Rutty, 2009;Weinstein et al, 2013), with such evidence possibly relating to the ongoing phenomenon of unnoticed/unrecognized concussive symptoms in these populations (Heath & Callahan, 2013;McCrea, Hammeke, Olsen, Leo, & Guskiewicz, 2004). Importantly, athletes who have not fully recovered from concussive symptoms are incomparably susceptible for recurrent concussion with greater, even fatal, post-concussion symptoms (Caron et al, 2013;Grace, 2013;Wetjen et al, 2010), securely establishing the preeminent need for continued research and awareness on recurrent concussion.…”