Background: Only a few patients with strokes following a suicide attempt (SFSA) are described in the literature. The best-known mechanism is the dissection of cervical arteries. We aimed to determine the frequency, clinical presentation, mechanisms, and outcomes of SFSA patients in one academic institution and in all patients reported in the literature.
Method: We retrospectively identified all SFSA in the Acute Stroke Registry and Analysis of Lausanne (ASTRAL) from 2003 to 2021. A thorough workup was performed to establish the stroke mechanism. We also searched for all published SFSA cases in the worldwide literature for further analysis of demographics, comorbidities, and medium-term outcome.
Results: In our center, SFSA frequency was six out of 6,767 patients (0.0009%), with 83% being male. Comparing all reported 22 patients (own and published) to non-SFSA patients in ASTRAL, SFSA patients were younger (median 51 vs 75 years), had higher National Institutes of Health Stroke Scale scores on admission (median 13 vs 6) and higher three-months mortality (36 vs 15%). The most frequent mechanism was carotid dissection from hanging (41%), however, multiple other stroke mechanisms have been found or suspected.
Conclusions: SFSA are rare and seem to affect younger patients presenting with more severe strokes and higher medium-term mortality. While carotid dissection emerged as the predominant cause, several other stroke mechanisms have been identified.