Isolated posterior inferior cerebellar artery stroke secondary to near-hanging: A case report

Abstract

Suicide is the eighth leading cause of death in males, while strangulation injuries account for approximately 2.5% of all traumatic deaths worldwide. Hanging or 'self-suspension' is a form of ligature strangulation where the pressure is produced by the weight of the body itself. It is easily accessible, comparatively painless, almost always suicidal and cheap method of committing suicide. These attributes make it one of the most common methods of committing suicide all over the world. We report a case of isolated posterior inferior cerebellar artery stroke secondary to hanging, (which is a very rare entity) in a 15 years old boy brought in an unconscious state following a suicide attempt to the emergency in GTBH, Delhi. He presented there with a Glasgow Coma Scale score of 6/15 ,ligature mark over the neck, normal vital signs with low oxygen saturation by pulse oximeter, cyanosis, subconjunctival hemorrhage and positive bilateral Babinski sign. The patient was intubated and put on ventilator support in view of respiratory failure. Patient's magnetic resonance imaging (MRI) brain was done which showed left posterior inferior cerebellar artery territory infarct with cytotoxic edema in bilateral thalami, most likely due to hypoxia. After vigorous treatment in the intensive care unit with fluid restriction, mannitol and intravenous antibiotics he was extubated and transferred to the general ward with glasgow coma scale score of 8/15 (E4V1M3). Later patient was discharged from the hospital and with an advice to follow up in medical and pshychiatry outpatient departments. Survival and recovery after partial hanging is possible if proper care is given as early as possible. We also need to understand the changes which adolescents face in their day to day life and hence be more alert to any social, emotional or professional stress in their life. Also, we should provide counseling and necessary support so that such accidents are deterred.