Quiescent bilateral carotid dissection following strangulation

Background: Internal carotid artery dissection is a widely recognised cause of acute cerebrovascular events. Bilateral internal carotid artery dissection is uncommon, attempted suicide by hanging represents a possible mechanism of direct vascular trauma and has previously been reported as a cause of bilateral internal carotid artery dissection. Case Presentation: Our case is a 45 year old male presenting to the emergency department with neurological symptoms suggestive of an acute ischaemic stroke. Significantly, this patient had a history of attempted suicide by hanging 4 years prior. Radiological investigations revealed an acute ischaemic infarct, incidental well-established infarct and bilateral ICAD. Further investigations to determine the underlying aetiology of the bilateral ICAD failed to identify a secondary cause. Conclusions: : Acute cerebrovascular events related to traumatic ICAD following hanging attempts have previously been reported. However, such reports have typically been temporally related to the time of trauma with patients developing neurological symptoms soon after the hanging attempt. We suggest a delayed manifestation of underlying vascular damage caused by the inciting neck trauma by prior hanging attempt. The potential for ICAD and anatomical vascular distortion secondary to attempted hanging indicates that this is a high-risk cohort, and consideration of selective vascular imaging of this group may be beneficial in the prevention of acute ischaemic stroke.