Ligature Strangulation

Suicide by ligature strangulation is suspicious for homicide (26). Investigation of the scene usually shows no signs of struggle (26). A suicide note may be found. A past psychiatric history including suicide attempts and ideation may be elicited.

External and internal findings assist in distinguishing suicide from a homicide (Table 2; Fig. 38).

Unusual ligatures have been used (e.g., elastic band, nylon stocking, torn clothing [26,179,184]). The deceased's hands can be close to or involved with tightening the ligature (Fig. 38; ref. 26).

Accidental ligature strangulation occurs in a variety of circumstances (185). The "long-scarf" syndrome refers to an incident in which an article of clothing around the

Fig. 38. (A) Suicidal ligature strangulation. (B) Positioning of fingers on shoelace cord progressively tightened it around the neck. (C) Horizontal neck furrow. Note intense cyanosis and cutaneous petechiae above constriction. Ocular petechiae were also present. (D) Dissection of tongue and larynx. Posterior view. Note intense congestion and hemorrhage (petechiae, confluent hemorrhages) above level of constriction (indicated by arrows).

Fig. 38. (A) Suicidal ligature strangulation. (B) Positioning of fingers on shoelace cord progressively tightened it around the neck. (C) Horizontal neck furrow. Note intense cyanosis and cutaneous petechiae above constriction. Ocular petechiae were also present. (D) Dissection of tongue and larynx. Posterior view. Note intense congestion and hemorrhage (petechiae, confluent hemorrhages) above level of constriction (indicated by arrows).

victim's neck becomes entangled, usually in a stationary or moving mechanical device (e.g., ski rope tow, snowmobile engine), and the clothing becomes increasingly constricted owing to the continued action of the machine (Fig. 39; refs. 48, 109, and 186-189). Blunt trauma can also be evident (190). Ligature strangulation deaths are seen in autoerotic asphyxia (see Subheading 2.7.1.).

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