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Intracerebral and subarachnoid hemorrhage after suicidal “near-hanging”

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Abstract

Hanging is one of the most common methods of attempting suicide with a fast occurring death and a high lethality rate. Depending on how fast the hanged individuals are found, they may be rescued, which is referred to as “near-hanging.” Whilst hypoxic and ischemic brain damage are common findings in hanging, intracranial hemorrhages seem to be a rare occurrence. To the authors’ knowledge, this is the first autopsy case report of an intracerebral and subarachnoid hemorrhage in a delayed death after incomplete hanging. We hypothesize that the combination of two mechanisms is involved in the development of such hemorrhages. First, the persistent venous hypertension during incomplete hanging causing endothelial damage resulting in vascular leakage. Second, the reperfusion of the brain due to recovery of venous blood return after the release form the rope. Whereas intracranial hemorrhage is not a common finding in daily autopsy cases of fatal hanging, it might be a severe complication in rescued cases.

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The data generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Adams N (1999) Near hanging. Emerg Med 11(1):17–21. https://doi.org/10.1046/j.1442-2026.1999.00314.x

    Article  Google Scholar 

  2. Brancatelli G, Sparacia G, Midiri M, D’Antonio V, Sarno C, Lagalla R (2000) Brain damage in hanging: a new CT finding. Neuroradiology 42(3):209–210. https://doi.org/10.1007/s002340050048

    Article  CAS  PubMed  Google Scholar 

  3. Nakajo M, Onohara S, Shinmura K, Nakajo M, Amitani H, Munamoto T, Baba Y (2003) Computed tomography and magnetic resonance imaging findings of brain damage by hanging. J Comput Assist Tomogr 27(6):896–900. https://doi.org/10.1097/00004728-200311000-00011

    Article  PubMed  Google Scholar 

  4. Kim TH, Lee SH, Kim DH et al (2017) Non-aneurysmal and non-traumatic subarachnoid hemorrhage after attempted suicide by incomplete hanging. Clin Exp Emerg Med 4(1):56–59. https://doi.org/10.15441/ceem.15.115

    Article  PubMed  PubMed Central  Google Scholar 

  5. Salim A, Martin M, Sangthong B, Brown C, Rhee P, Demetriades D (2006) Near-hanging injuries: a 10-year experience. Injury 37(5):435–439. https://doi.org/10.1016/j.injury.2005.12.013

    Article  PubMed  Google Scholar 

  6. Sauvageau A, Boghossian E (2010) Classification of asphyxia: the need for standardization. J Forensic Sci 55(5):1259–1267. https://doi.org/10.1111/j.1556-4029.2010.01459.x

    Article  PubMed  Google Scholar 

  7. Saukko PJ, Knight B (2015) Knight’s forensic pathology, 4th ed. CRC Press, London. https://doi.org/10.1201/b13266

  8. Bradshaw DA, Amundson DE (1994) Complications of suicidal hanging: a case report and brief review. Mil Med 159(11):720–721

    Article  CAS  Google Scholar 

  9. Šupe S, Poljaković Z, Habek M, Pavliša G, Stojanović-Špehar S (2013) A near-hanging patient with PTSD and acute stroke - an unusual condition for “off label” thrombolysis. Psychiatr Danub 25(2):185–187

    PubMed  Google Scholar 

  10. Atreya A, Kanchan T (2015) Clinico-epidemiological study of near-hanging cases - an investigation from Nepal. J Forensic Leg Med 33:35–38. https://doi.org/10.1016/j.jflm.2015.04.001

    Article  PubMed  Google Scholar 

  11. Sandhu AS, Johns D, Albertyn LE (1991) Deep cerebral vein thrombosis. Neuroradiology 33:241–243. https://doi.org/10.1007/978-3-642-49329-4_78

    Article  Google Scholar 

  12. Schröder R, Saternus KS (1983) Stauungszeichen im Kopfbereich und Veränderungen am Gehirn beim suicidalen Erhängungstod [Congestion in the area of the head and changes in the brain caused by suicidal hanging death]. Z Rechtsmed 89(4):247–265. https://doi.org/10.1007/BF00203729

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

We want to thank Juan Carlos Borondo, MD, for the discussion of the histological findings. Special thanks also address the technicians and personnel staff of the Institute of Legal Medicine and Forensic Science of Catalonia (IMLCFC) and the Instituto Nacional de Toxicología y Ciencias Forenses (INTyCF), Departamento de Barcelona.

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Authors and Affiliations

  1. Forensic Pathology Service, Catalonian Institute of Legal Medicine and Forensic Science (IMLCFC), Ciutat de la Justícia, Gran Via de les Corts Catalanes, 111 Edifici G, 08075, Barcelona, Spain

    Nathalie Schwab & Ignasi Galtés

  2. Departamento de Barcelona, Instituto Nacional de Toxicología y Ciencias Forenses (INTyCF), Ministerio de Justicia, Barcelona, Spain

    Lorena Díaz

  3. Departament de Psiquiatria i Medicina Legal, Unitat de Medicina Legal i Forense, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain

    Ignasi Galtés

Authors
  1. Nathalie Schwab
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  2. Lorena Díaz
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  3. Ignasi Galtés
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Contributions

Conceptualization: Ignasi Galtés, Nathalie Schwab; methodology: Lorena Díaz; formal analysis and investigation: Ignasi Galtés, Nathalie Schwab, Lorena Díaz; writing — original draft preparation: Nathalie Schwab; writing — review and editing: Ignasi Galtés, Nathalie Schwab; visualization: Nathalie Schwab; supervision: Ignasi Galtés.

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Correspondence to Ignasi Galtés.

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Informed consent is not necessary in this work because it was a judicial–autopsy case. The report does not contain personal data.

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The authors declare no competing interests.

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Schwab, N., Díaz, L. & Galtés, I. Intracerebral and subarachnoid hemorrhage after suicidal “near-hanging”. Int J Legal Med 136, 1359–1362 (2022). https://doi.org/10.1007/s00414-022-02832-y

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  • DOI: https://doi.org/10.1007/s00414-022-02832-y

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