Abstract
Dear Editor
We read with keen interest the case presented by Prasad DR and Manjula S recently published online in your journal. 1 They have presented a 38-year-old man who had been referred to them after suicidal hanging for about six–eight minutes with SPo2 = 42%, decreased level of consciousness, myoclonus and ligature mark. They have conservatively managed the patient and apparently, after a six-week period, the patient has recovered. Although an interesting case, some concerns a rise while reading it. First of all, the authors have mentioned that the patient had been normal and seen 30 minutes before being found hanged and then declare that he had been suspended for six–eight minutes. Do they have a witness for their claim? How do they know that the patient had been suspended for six–eight minutes and not less? We assume they believe this because of the decreased level of consciousness, myoclonus and ligature mark. However, as they have themselves stated, the exact minimum time for development of none of these signs is clear. Secondly, they have not fully explained the patient's recovery period. For instance, they have not mentioned anything about the patient's neurological examination during the hospital stay and by the end of the sixth week. It is not clear whether he has completely recovered without even minimal neurological deficits. Finally, uncomplicated recovery has been reported in several hanging cases 2 even in those who had been referred with coma, 3–5 poor clinical status 6 and pulmonary oedema. 7 It is assumed therefore that maybe, as Karanth and Nayyar 8 have previously stated, late presentation to the health care facility is a better prognostic factor in hanged patients. Why do the authors of the present study believe that their patient is so different from all other patients previously reported with complete recovery after hanging? Thank you for this interesting case.