A neurological audit in Vitoria, Spain.

The neuropsychology of hanging: an historical perspective Medalia, Merriam and Ehrenreich' reported two cases of attempted hanging with subsequent isolated memory defects. Their report is particularly interesting, as hanging is still one of the most common methods of committing suicide. How death occurs during hanging and how, when and why the brain's activity is altered by strangulation, has been the subject of much debate. Medalia et al ignore this literature, and instead incorrectly emphasise in the first sentence of their abstract that "only one report on the neuro-psychological sequelae of attempted hanging exists in the English literature".' In 1983 a report by Mengech2 described "Strangulation as a cause of Korsakoff psy-chosis". Other English-language reports on the neuropsychological consequences of attempted hanging stem from Whiteley3 and Stengel.' Furthermore, there is a considerable amount of early German-language literature on the neurological and neuropsychological consequences of unsuccessful attempts at hanging.' 6Already in 1896 Boediker7 described attempted hanging as usually resulting in retrograde amnesia. Two of the first detailed reports of such cases were given byWagner89 in Southeastern Austria. In his article from 1889k he referred to 17 previous cases which had been described in the years between 1826-87. Wagner9 also mentioned Leides-dorf,"' who had given examples of cases related to hanging. Leidesdorf"' for example wrote: "The rope which the Sibierian Shaman allows to be laid around his throat, until, shortly before choking, he goes into Of principal importance are Wagner's publications and a related report of Pick (which is cited in Wagner9) as both emphasised the time point of the onset of retrograde amnesia before hanging. Wagner9 noted that attempted hanging usually resulted in severe memory disturbances which he characterised as "dementia acuta", but that these amnesic states were usually only temporary; in a few cases he noted that the reverse pattern might even follow, namely an improvement of amnestic functions or the cure of a psychosis. A few years later, Wollenberg" described a 39 year old carpenter, who hanged himself during a stay in a psychiatric clinic, to which he had been admitted with paranoia and because he had tried to hang himself eight days earlier. Wollenberg assumed that a preceding loss of consciousness was an important requirement for retrograde amnesia to occur, though unconsciousness did not necessarily lead to retrograde amnesia."2 13