Pathophysiology

Hanging occurs when pressure is exerted on the neck and then tightened by the weight of the victim's body. Hangings in which the body is suspended and the feet do not touch the ground are termed "complete." These generally occur with judicial hangings. All other positions of the body, when the feet are in contact with the ground, are referred to as "incomplete." The mechanism of death may differ depending on the method of hanging. If a victim drops a distance equal to his height, death usually results from fracture of the upper cervical spine and transection of the spinal cord. If a hanging is incomplete, or the victim drops a distance less than his height, the cervical spine is spared. Constriction causes jugular venous obstruction, stagnant cerebral blood flow and brain ischemia. Loss of consciousness results. Muscle tone decreases and compression of vital structures increases. Complete arterial occlusion and/or airway compromise result in death. Alternatively, cardiac arrest may occur due to carotid sinus stimulation and increased vagal tone.

In ligature and manual strangulation, the constricting force is external, but the weight of the body and head play no part. Postural strangulation is seen in infants. This results when the victim's neck is placed over an object and the weight of the body adds pressure to the neck. In all of these methods of strangulation, death probably results from airway obstruction (suffocation) or vascular occlusion, as previously described in incomplete hangings.

Fracture of the thyroid cartilage, hyoid, and larynx are associated with strangulation. Traumatic edema of the larynx and supraglottic tissue lead to airway compromise. Delayed mortality is often due to neurogenic pulmonary edema and aspiration pneumonia. Cerebral anoxia may cause neurologic damage. Neurologic deficits are not always immediately apparent, and may develop over time. Long-term psychiatric manifestations include psychosis, Korsakoff's syndrome, amnesia, and progressive dementia.

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