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Child Neuropsychology

A Journal on Normal and Abnormal Development in Childhood and Adolescence
Volume 11, 2005 - Issue 4
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Original Articles

Neuropsychological profile following suicide attempt by hanging: two adolescent case reports

, , &
Pages 373-388
Published online: 16 Feb 2007

Hippocampal damage and amnesia following hypoxia and ischemia are described in the few published adult cases of suicide attempt by hanging. However, a recent review (Caine & Watson, 2000 Caine, D. and Watson, J. D. 2000. Neuropsychological and neuropathological sequelae of cerebral anoxia: A critical review. Journal of the International Neuropsychology Society, 6: 8699. [CROSSREF][Crossref], [PubMed], [Web of Science ®] [Google Scholar]) suggests a variable pattern of brain involvement and neuropsychological impairments following hypoxic-ischemic injury that may or may not involve amnesia. To help clarify the impact of hanging on the developing brain, we examined neuropsychological functioning in two adolescents who survived suicide attempt by hanging. Despite differences in Glasgow Coma Scale (GCS), coma duration, and structural imaging findings, both patients had similar IQ (VIQ > PIQ) and presented with various combinations of deficits in expressive/receptive language, visual-constructional and perceptual ability, processing speed, attention, working memory, and/or executive functioning shortly after injury. In spite of their similarities, only one of the patients presented with classic amnesia symptoms in his early recovery. This patient was evaluated 1 year postinjury, and persistent deficits in processing speed and memory encoding were noted. Several hanging-related variables, including longer estimated hanging duration, greater weight, and severe airway edema, were thought to place this patient at increased risk for cognitive deficits. Clinical MRI scans of this patient obtained 6 weeks postinjury revealed mild volume loss as well as abnormalities in bilateral superior cortex. However, CT and MRI scans obtained throughout early recovery did not reveal overt evidence of injury to specific memory-related structures. Comprehensive neuropsychological evaluation of all adolescent survivors of suicide attempt by hanging is recommended, as a variety of postacute cognitive deficits were observed in these patients despite relatively short (≤ 15 minutes) estimated hanging durations.

Acknowledgments

We would like to thank Dr. Michael Kraut of the Johns Hopkins University School of Medicine for assistance in reviewing the patients’ CT and MRI scans.

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