Complete Neurological Recovery Following Suicidal Near-Hanging: A Case Report From Ethiopia

Introduction: Near-hanging is a common method of attempted suicide that can cause severe hypoxic brain injury, and survivors often require intensive care. We report a near-hanging case in a resource-limited setting with full neurological recovery despite an initially severe presentation. Case Presentation: A previously healthy 22-year-old man presented in mid-2025 unconscious after being rescued from a hanging incident. He had no known psychiatric history or prior suicide attempt. On arrival, he was comatose (Glasgow Coma Scale 6) with stable vital signs. Head CT was unremarkable for acute injury. Airway was secured by rapid sequence intubation without complication; cervical spine immobilization was applied, and imaging revealed no cervical or laryngeal trauma. A bedside ultrasound measurement of the optic nerve sheath diameter (ONSD) was performed (resource-limited setting, MRI unavailable). Management and Outcome: The patient received standard intensive care support, including mechanical ventilation, sedation, and monitoring of oxygenation and perfusion. His blood glucose and metabolic status were managed carefully. The initially elevated ONSD prompted continued neuroprotective care. Over 72 hours, he gradually regained consciousness and was extubated on day 4. He exhibited no focal deficits or cognitive impairment. By discharge on day 7, he had returned to baseline neurologic function and was oriented with normal examination. Conclusion: This case highlights that even severe near-hanging can have excellent neurologic recovery. It also underscores that a normal head CT in the acute period does not exclude significant hypoxic brain injury. In settings without advanced imaging, bedside ONSD ultrasonography may provide useful information about intracranial dynamics. Clinicians should be aware of these diagnostic and prognostic nuances and maintain aggressive supportive care in such cases.