English

Sharma Abha,Bhardwaj Shivendu,Jhamb Rajat,V Madhu S

doi:10.5897/jcpfm2017.0078

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. Key words: Near-hanging, posterior inferior cerebellar artery stroke.

Highlights

Suicide is the eighth leading cause of death in males, while strangulation injuries account for approximately 2.5% of all traumatic deaths worldwide (Omalu et al, 2011)
We report a case of isolated posterior inferior cerebellar artery stroke secondary to hanging, which is a very rare entity and no case report could be found with similar finding in literature
There are two major types of hanging: Judicial hanging, in which the body drops a distance greater than the body height and death occurs by spinal cord transection and non-judicial hanging, where there is no significant drop and injury occurs due to compression of neck structures

Summary

INTRODUCTION

Suicide is the eighth leading cause of death in males, while strangulation injuries account for approximately 2.5% of all traumatic deaths worldwide (Omalu et al, 2011). Carotid artery injuries in patients who have tried to commit suicide by hanging occur in approximately 3% of victims, either as dissection or occlusions, which may be unilateral or bilateral (Singhal et al, 2002). Treatment options in cases with acute cerebral infarction are limited due to abundant comorbidity and numerous contraindications for intravenous thrombolytic therapy that usually accompany near-hanging victims, primarily acute bleeding and bone fractures (Svjetlana et al, 2013). A Hindu male aged 15 years male presented in emergency (Guru Tegh Bahadur Hospital, Delhi) with an alleged history of attempted suicide by hanging. He was found hanging from ceiling fan at his home and was rushed to the hospital thereafter by some coworkers.

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