Cervical near-hanging injuries are most frequent in the young adult population. However, the literature gives little guidance regarding diagnostic evaluation of these patients, although it is well known that their initial clinical presentation has limited prognostic value. This case report presents a patient who actually survived a suicidal near-hanging attempt and was later able to walk and talk to his physician. He died the next day due to carotid dissection and cerebral ischemia. In this case report we emphasize the importance of thorough radiological investigation in the accurate assessment of these patients. Early imaging should be performed routinely after near-hanging injury, in order to establish the correct diagnosis and allow appropriate treatment to be started.