Quiescent Bilateral Internal Carotid Artery Dissection Following Strangulation

Abstract

Bilateral internal carotid artery dissection is uncommon and suicide attempts by hanging represent a potential mechanism of direct vascular trauma. Previous reports have documented similar events and awareness is important as internal carotid artery dissection is an extensively recognized cause of acute cerebrovascular events. Our case is of a patient presenting with symptoms suggestive of an acute stroke. Significantly, there was a past medical history of an attempted suicide by hanging 4 years before this admission. Imaging demonstrated bilateral internal carotid artery dissection, an acute ischemic infarct and an incidental well-established infarct. Further investigations to assess an underlying aetiology of the bilateral internal carotid artery dissection were unsuccessful in identifying a secondary cause. Acute intracranial episodes related to traumatic internal carotid artery dissection following suicide attempts by hanging have previously been documented. However, such reports have frequently been temporally related to the period of trauma with patients developing neurological symptoms within a short timeframe after the hanging attempt. We hypothesize a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for internal carotid artery dissection and vascular distortion secondary to attempted hanging are suggestive of a high-risk cohort, and consideration of selective vascular imaging investigations of this group may be useful in acute stroke prevention.