title: Neuropsychological profile following suicide attempt by hanging: two adolescent case reports.
abstract: 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) 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 (<or=15 minutes) estimated hanging durations.
authors.affiliation: Department of Neuropsychology, Kennedy Krieger Institute and Johns Hopkins University School of Medicine, Baltimore, MD 21231, USA. zabela@kennedykrieger.org
authors.forename: T Andrew
authors.initials: TA
authors.lastname: Zabel
authors.forename: Beth
authors.initials: B
authors.lastname: Slomine
authors.forename: Kathy
authors.initials: K
authors.lastname: Brady
authors.forename: James
authors.initials: J
authors.lastname: Christensen
mesh_terms: D000293:Adolescent; D002560:Cerebrovascular Circulation / Q000502:physiology; D002648:Child; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology*; D004569:Electroencephalography; D006624:Hippocampus / Q000098:blood supply* / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D020925:Hypoxia-Ischemia, Brain / Q000209:etiology* / Q000503:physiopathology*; D008279:Magnetic Resonance Imaging; D008297:Male; D009483:Neuropsychological Tests; D012720:Severity of Illness Index; D013406:Suicide, Attempted / Q000523:psychology*; D013997:Time Factors