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Billy May and TBI: Another Closed Head Injury Death?

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Doctors are looking at a traumatic brain injury (TBI) as the possible cause of the tragic death of TV actor Billy May as Mike Bryant of Minnesota has reported recently in:

Doctors Will Be Looking At Potential Head Injury With Billy May’s Death.

Everyone should be on alert that a blow to the head can start a small bleeding process in the brain that is unknown to the person whose head was hit – and can lead to death. Often the person is either unconscious for a period of time, or dazed. After a few moments the person goes through what doctors call a lucid interval where they seem OK.

This article is about the medical sign. For the Cephalic Carnage album, see Lucid Interval.

In emergency medicine, a lucid interval is a temporary improvement in a patient’s condition after a traumatic brain injury, after which the condition deteriorates. A lucid interval is especially indicative of an epidural hematoma. An estimated 20 to 50% of patients with epidural hematoma experience such a lucid interval.[1][2] The lucid interval occurs after the patient is knocked out by the initial concussive force of the trauma, then lapses into unconsciousness again after recovery when bleeding causes the hematoma to expand past the point at which the body can no longer compensate.[3] After the injury, the patient is momentarily dazed or knocked out, and then becomes relatively lucid for a period of time which can last minutes or hours.[3] Thereafter there is rapid decline as the blood collects within the skull, causing a rise in intracranial pressure, which damages brain tissue. In addition, some patients may develop "pseudoaneurysms" after trauma which can eventually burst and bleed, a factor which might account for the delay in loss of consciousness.[4]

Because a patient may have a lucid interval, any head trauma is regarded as a medical emergency and receives emergency medical treatment even if the patient is conscious.

Delayed cerebral edema, a very serious and potentially fatal condition in which the brain swells dramatically, may follow a lucid interval that occurs after a minor head trauma.[5]

Lucid intervals may also occur in conditions other than traumatic brain injury, such as heat stroke[6] and the postictal phase after a seizure in epileptic patients.[7]

The skull is solid and the brain is soft. Increasing the pressure with an internal bleeding process is a catastrophe waiting to happen.

I handled a TBI case years ago that I will never forget. A man hit is head when he fell off a ladder in his yard while trimming a tree. His wife was with him and got to him immediately. His eyes were open but when she asked if he was hurt he did not respond. He never was "unconscious" as we usually think of it. That was at 9 o’clock in the morning. By 5 PM he was dead. He went to his family doctor who asked him some questions that he answered correctly. The doctor did not order a CT Scan.

The 20th century has seen critical developments in diagnosis and treatment which have decreased death rates and improved outcome. These include imaging techniques such as computed tomography and magnetic resonance imaging. Depending on the injury, treatment required may be minimal or may include interventions such as medications and emergency surgery. Physical therapy, speech therapy, and occupational therapy may be employed for rehabilitation.

During the afternoon the man slept at home and his headache worsened. He was unresponsive at 5 PM at home. Tragic. A CT scan might have shown the insidious bleed and treatment would have been available.

These head injuries are a leading cause of death in the United States from trauma:

Traumatic brain injury (TBI) is a leading cause of death and disability among persons in the United States. Each year, an estimated 1.5 million Americans sustain a TBI. As a result of these injuries, 50,000 people die, 230,000 people are hospitalized and survive, and an estimated 80,000-90,000 people experience the onset of long-term disability. Rates of TBI-related hospitalization have declined nearly 50% since 1980, a phenomenon that may be attributed, in part, to successes in injury prevention and also to changes in hospital admission practices that shift the care of persons with less severe TBI from inpatient to outpatient settings. The magnitude of TBI in the United States requires public health measures to prevent these injuries and to improve their consequences. State surveillance systems can provide reliable data on injury causes and risk factors, identify trends in TBI incidence, enable the development of cause-specific prevention strategies focused on populations at greatest risk, and monitor the effectiveness of such programs. State follow-up registries, built on surveillance systems, can provide more information regarding the frequency and nature of disabilities associated with TBI. This information can help states and communities to design, implement, and evaluate cost-effective programs for people living with TBI and for their families, addressing acute care, rehabilitation, and vocational, school, and community support.

Billy May was far too young to die. The first lesson is to get to a doctor or hospital immediately. The second is to look for the subtle signs and symptoms of an internal bleed in the head.