Cervical spinal cord injury following near-hanging without associated cervical fracture: a case report

Background: Hanging injuries are primarily associated with hypoxic-ischemic brain damage due to vascular compression, rather than airway obstruction. Spinal cord injury in this context is exceedingly rare, particularly when no bony abnormality is present. Only a limited number of cases of cervical spinal cord injury after hanging have been reported, most without radiographic abnormalities resembling spinal cord injury without radiographic abnormality (SCIWORA). We present an additional rare case of cervical spinal cord injury following near-hanging in an elderly patient, focusing on diagnostic and pathophysiological considerations rather than uniqueness. Case Description: A 70-year-old man with no psychiatric history was found in a near-hanging position in a vinyl greenhouse storage area. Cardiopulmonary resuscitation (CPR) was initiated by his spouse and continued for approximately 10 minutes. Return of spontaneous circulation was achieved after one additional cycle of CPR in the emergency department. On examination, he was semicomatous (Glasgow Coma Scale score 8) with quadriparesis (grade I). Cervical radiographs and computed tomography (CT) were normal. Magnetic resonance imaging (MRI) revealed diffuse T2-hyperintense intramedullary edema of the cervical cord without fracture or ligamentous injury. Conservative management was undertaken; however, no significant neurological recovery occurred. Conclusions: Cervical spinal cord injury following near-hanging, particularly in the absence of bony injury, is a rare but clinically significant entity. MRI is indispensable for diagnosis in patients with neurological deficits after hanging.