Presentation
Hanging suicide attempt.
Patient Data
CT Brain:
There is subtle loss of normal grey white differentiation in comparison to posterior fossa contents, which can be an early CT sign of hypoxic-ischemic encephalopathy. Possible subtle sulcal effacement. No intracranial hemorrhage is identified.
No hydrocephalus. No subfalcine, uncal or tonsillar herniation. No skull fracture or bony abnormality.
CT Cervical Spine:
Patient has been intubated with NGT in situ.
Straightening of the cervical alignment. No fracture of the cervical spine is identified.
Large hematoma is seen within the right neck grossly expanding the right levator muscles and anteriorly displacing the swollen sternocleidomastoid muscle. Further hematoma superficial to sternocleidomastoid. Fluid tracks along the posterior cervical space.
Confluent consolidation is seen within the dependant lungs bilaterally with more widespread patchy ground glass changes, consistent with aspiration.
Conclusion:
1. CT findings raise possibility of hypoxic brain injury.
2. No cervical spine fracture
3. Large right neck hematoma involving paravertebral muscles and anteriorly displacing the sternocleidomastoid, secondary to known history of hanging. If there is concern for dissection or active bleeding, a contrast study could be performed.
4. Consolidation within the dependant lungs bilaterally, likely from aspiration.
There is diffuse edema and loss of normal grey-white differentiation. Hypoattenuation of the cerebral hemispheres with sparing of the cerebellum is seen along with hyperdense falx cerebri and tentorium cerebelli relative to brain parenchyma, giving the appearance of pseudosubarachnoid hemorrhage. These appearances are consistent with hypoxic- ischemic brain injury.
There is an increased mass effect with tonsillar and uncal herniation, and slit-like effacement of the lateral and third ventricles. No midline shift or uncal herniation. No intracranial hemorrhage is identified.
Conclusion:
Features in keeping with hypoxic brain injury with increased mass effect.
Case Discussion
This tragic case demonstrates the features of profound global hypoxic ischemic brain damage with hypodensity of parenchyma and swelling resulting in a pseudo-subarachnoid sign.
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