Should CT angiography of the supra-aortic arteries be performed systematically following attempted suicide by hanging?

PURPOSE: Characterize and determine the frequency of dissections of the supra-aortic arteries (SAA) and injuries to the cervical spine and pharyngolaryngeal cartilages viewed on CT scans after an attempted suicide by hanging. MATERIALS AND METHODS: A retrospective, single-centre study of all patients admitted for attempted suicide by hanging between January 2010 and June 2017 who received CT angiography of the SAA. Search for signs of dissection of the cervical arteries and injuries to the brain, spinal column and pharyngeal and laryngeal cartilages. The results were compared with the initial clinical severity, which was assessed indirectly by whether patients were initially admitted in an intensive care unit (ICU) or in an emergency department (ED). RESULTS: Out of 162 patients included, 4 presented with SAA dissection (2.5%), comprising 3 vertebral arteries and 1 external carotid artery. The cases in question were of 4 men, all in cardiac arrest on arrival and all were treated in ICU. Of the most serious cases, 18/72 (25%) had anoxia-related injuries and one also presented with a C2 fracture. No vascular lesions or signs of cerebral anoxia were observed in the 90 ED patients. Nevertheless, pharyngeal and laryngeal fractures were observed in both groups, with no significant difference. CONCLUSION: In our study, 2.5% of CT angiograms performed after an attempted hanging revealed SAA dissection. Crucially, only most severe patients, who have been immediately admitted to ICU suffered SAA. These results call into question the systematic indication of this exam in cases of hanging attempts.

Standard Diffusion-Weighted Imaging in the Brain Can Detect Cervical Internal Carotid Artery Dissections.

BACKGROUND AND PURPOSE: The ICA is the most common site of cervical artery dissection. Prompt and reliable identification of the mural hematoma is warranted when a dissection is clinically suspected. The purpose of this study was to assess to capacity of a standard DWI sequence acquired routinely on the brain to detect dissecting hematoma related to cervical ICA dissections. MATERIALS AND METHODS: This was a retrospective study of a cohort of 110 patients younger than 55 years of age (40 women; mean age, 46.79 years) admitted at the acute phase of a neurologic deficit, headache, or neck pain and investigated by at least a standard 3T diffusion-weighted sequence of the brain. Among them were 50 patients (14 women; mean age, 46.72 years) with subsequently confirmed ICA dissection. In the whole anonymized cohort, both a senior and junior radiologist separately assessed, on the DWI sequences only, the presence of a crescent-shaped or circular hypersignal projecting on the subpetrosal segment of the ICA arteries, assuming that it would correspond to a mural hematoma related to an ICA dissection. RESULTS: The senior radiologist found 46 subpetrosal hyperintensities in 43/50 patients with ICA dissection and none in patients without dissection (sensitivity, 86%; specificity, 100%). The junior radiologist found 48 subpetrosal hyperintensities in 45/50 patients with dissection and none in patients without dissection (sensitivity, 90%; specificity, 100%). CONCLUSIONS: In our cohort, a standard DWI sequence performed on the brain at the acute phase of a stroke or for a clinical suspicion of dissection detected nearly 90% of cervical ICA dissections.