Diagnostic and therapeutic management of bilateral carotid artery occlusion caused by near-suicidal hanging

In cases of attempted suicide by hanging, a combination of mechanisms causi ng local destruction of the pharynx, larynx, vessels, and spine, as well as neurologic complications, has to be considered. We present a case of hangi ng in which a deeply unconscious patient without any palpaple pulsation of the carotid arteries was referred to our otolaryngology department. Compute d tomography and angiography showed parapharyngeal air, complete obstructio n of both common carotid arteries, and a compensatory circulation through t he vertebral arteries. Three hours after the trauma, surgical exploration w ith 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 slow ly declined during the following months, and the patient learned swallowing again perfectly. We conclude from our experience that in near-hanged patie nts a prompt onset of adequate diagnostic and therapeutic measures is manda tory, as good neurologic and functional results map occur even in cases wit h coma and severe destruction of the carotid arteries and pharyngeal and la ryngeal structures. Surgical repair of blunt carotid lesions is recommended and may be crucial for a good outcome.