Diagnostic and Therapeutic Management of Bilateral Carotid Artery Occlusion Caused by Near-Suicidal Hanging

Abstract

In cases of attempted suicide by hanging, a combination of mechanisms causing local destruction of the pharynx, larynx, vessels, and spine, as well as neurologic complications, has to be considered. We present a case of hanging in which a deeply unconscious patient without any palpaple pulsation of the carotid arteries was referred to our otolaryngology department. Computed tomography and angiography showed parapharyngeal air, complete obstruction of both common carotid arteries, and a compensatory circulation through the vertebral arteries. Three hours after the trauma, surgical exploration with resection of the enrolled intima of both carotid arteries and repair of the pharynx was performed. The patient awoke with an infarct of the right hemisphere with incomplete left hemiparesis the next day, but symptoms slowly declined during the following months, and the patient learned swallowing again perfectly. We conclude from our experience that in near-hanged patients a prompt onset of adequate diagnostic and therapeutic measures is mandatory, as good neurologic and functional results may occur even in cases with coma and severe destruction of the carotid arteries and pharyngeal and laryngeal structures. Surgical repair of blunt carotid lesions is recommended and may be crucial for a good outcome.

Bilateral common carotid artery occlusion — A case report and literature review

“…Key words in the search included ''common carotid artery occlusion'', ''internal carotid artery occlusion'' and ''bilateral''. There were 105 cases of unilateral CCA occlusion and 209 cases of bilateral ICA occlusion in the literature [1][2][3][8][9][10][11][12][13][14][15][16][17][18][19][20]. Seven cases of bilateral CCA occlusion were found, including six cases [4][5][6][7] reported in the literature and our one case.…”

Pulmonary distress following attempted suicidal hanging

“…[15][16][17][18][19] The absence of any spinal cord injury in this series is similar to an earlier series published from the same institute and to the observations made by several other authors. [20][21][22] This study for the Þ rst time draws attention to the fact that pulmonary distress is a comparatively common complication of hanging, and demonstrates that it is an independent predictor of mortality. The P/F ratio has not previously been used to quantify the severity of post-hanging pulmonary distress, and it was found to be an accurate indicator of prognosis in these patients, with a P value of <0.001.…”

Cryptogenic Stroke in Hanging

“…The MR imaging study (3.0 Tesla, Achieva, Philips MediHanging is one of the most common methods of suicide and is also practised for capital punishment 1 . For patients who survive the hanging, injuries are documented mostly in case reports [2][3][4][5][6] . Cerebral hypoxia rather than spinal cord injury is the cause of death in the majority of autopsied cases and should be the primary concern in treatment of patients who have survived a hanging event.…”